Chapter 5
Alcohol: Treating the Disease

For much of the first half of the twentieth century, people who wanted to quit drinking had a difficult time finding help. Pulitzer Prize–winning journalist and novelist Nan Robertson, who fought and won her own battle with alcoholism, describes the few dismal options available to alcoholics of that period to aid them in dealing with their problem:

There were only two ways for a drunk to go if the family wouldn't take care of him or he couldn't afford a "drink cure" in a fancy sanitarium––to the drunk tank in jail or to the insane asylum. In those days alcoholics who wound up in [mental institutions] were locked in wards with criminal psychopaths and those afflicted with senile dementia. Nobody knew what else to do with them.⁵⁹

Until the American Medical Association officially recognized alcoholism as a disease during the 1960s, most people believed that drunkards (the term once used to refer to alcoholics) drank because they were morally degenerate and that it was a waste of time to try to help them. This belief is embodied in the comments of J. E. Todd, a Connecticut doctor who, on June 21, 1882, cruelly proclaimed, "Every human soul is worth saving; but what I mean is, that if a choice is to be made, drunkards are about the last class to be taken hold of."⁶⁰

Attitudes changed dramatically once the medical establishment and society in general began to believe that people drank uncontrollably because they were suffering from an illness and not because they had character flaws that made them morally inferior. In Contested Meanings: The Construction of Alcohol Problems, Joseph R. Gusfield explains this transformation:

For the nineteenth century and the first third of the twentieth, the habitual drunkard was someone to be condemned as a sinner and pitied for his moral limitations. He bore the stigma of the sinner. With the disease theory of alcoholism, he was a victim of illness . . . he was an object of help, not condemnation.⁶¹

It is now generally accepted that alcoholism is an illness, one that can be treated like any other disease, and alcoholics today who want to quit have a wide variety of treatment options from which to choose. However, no treatment will ever work until the alcoholic acknowledges the depth of his or her drinking problems. For most alcoholics, this step does not come easily.

Do You Have A Drinking Problem?

Many tests can help people determine if they have a drinking problem. This test, which uses a simple question-and-answer format, can be found in a booklet entitled "Alcoholism" from the National Institute on Alcohol Abuse and Alcoholism.

How can you tell whether you, or someone close to you, may have a drinking problem? Answering the following four questions can help you find out. (To help remember these questions, note that the first letter of a key word in each of the four questions spells "CAGE.")

Have you ever felt you should Cut down on your drinking?

Have people Annoyed you by criticizing your drinking?

Have you ever felt bad or Guilty about your drinking?

Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eyeopener)?

One "yes" response suggests a possible alcohol problem. If you responded "yes" to more than one question, it is highly likely that a problem exists. In either case, it is important that you see your doctor or other health care provider right away to discuss your responses to these questions. He or she can help you determine whether you have a drinking problem and, if so, recommend the best course of action for you. Even if you answered "no" to all of the above questions, if you are encountering drinking-related problems with your job, relationships, health, or with the law, you should still seek professional help. The effects of alcohol abuse can be extremely serious—even fatal—both to you and to others.

Denial

Many alcoholics—even those who have been fired from jobs, have been jailed for drunk driving, and have lost the love of their family and friends because of their drinking—cannot admit the damage done by their alcohol use. This attitude is commonly known as denial. Barbara McCrady, a professor of psychology and the clinical director of the Center for Alcohol Studies at Rutgers University in New Brunswick, New Jersey, explains that denial is the biggest obstacle to recovery facing an alcoholic: "If a person doesn't recognize that his or her behavior is creating problems, then he or she wouldn't see the need to change or seek assistance."⁶²

Alcoholics use denial as a psychological defense mechanism to justify their continued drinking and to wipe away the painful reality of their drinking. This is how denial worked in the mind of Chris, who, despite her heavy drinking, believed her life was perfectly normal:

I went to Girl Scout meetings with a load on; held children's parties while imbibing; even taught my daughter how to drive after I had belted down a few. My marriage was horrendous, and I saw no way out. And yet I still believed I was the All-American Housewife.⁶³

Sometimes the only way to get alcoholics to realize they have a problem is to directly confront them with their drinking. This can be a difficult, emotionally wrenching task for the people who are involved in trying to save the alcoholic.

Intervention

Interventions are important because they can help alcoholics overcome their denial about the problems caused by their drinking. In an intervention, family members, friends, coworkers, and other key people in the drinker's life band together to talk to the individual about how his or her drinking is affecting them.

Whether this is done in a doctor's office, a hospital, or at the person's home, it can be an extremely painful experience for everyone involved. The alcoholic may break down in tears when loved ones explain how the drinker's behavior has hurt them, and they may also be crying because of the outpouring of pent-up emotions. Interventions can also be angry affairs; the alcoholic may continue denying the problem, and other people may be overcome by resentment or bitterness in discussing all of the things the drinker has done to ruin their lives.

Former first lady Betty Ford, who has spoken publicly about her drinking, admits she was upset at first when confronted by members of her family and others. Recalls Ford, "All of them hurt me [with their stories about Ford's drinking]. I collapsed into tears. But I still had enough sense to realize they hadn't come around just to make me cry; they were there because they loved me and wanted to help me."⁶⁴ The intervention made Ford realize how severe her drinking had become and she sought treatment and was able to quit.

The most important step drinkers take toward recovery is to finally admit to themselves, as Ford did, that they have to quit. Although alcoholics will need a great deal of help to do this, fortunately today they have a wide variety of care options from which to choose.

Detox

The first step for many alcoholics is a detoxification center—a medical facility where medical personnel help them sober up and treat them for the physical symptoms brought on by alcohol withdrawal. It can take anywhere from three to six days for heavy drinkers to purge all of the alcohol from their bodies. During this period, which is known as withdrawal, alcoholics can suffer severe, even life-threatening physical and psychological reactions.

The symptoms of withdrawal include trouble sleeping, disorientation, hallucinations, convulsions, and seizures. The most extreme form of withdrawal is known as delirium tremens, DTs, a condition that is accompanied by acute anxiety and fear, agitation, fast pulse, fever, extreme perspiration, and hallucinations. Detoxification centers are staffed by doctors and other personnel who monitor and help alcoholics with their withdrawal symptoms. In severe cases, doctors can administer medication to lessen the symptoms.

Intervention

Because so many alcoholics refuse to admit they have a problem, an intervention is often useful in making them realize the tragic consequences of their drinking. In Alcohol Problems and Alcoholism: A Comprehensive Survey, James E. Royce discusses this form of encounter.

Very often the most effective way to motivate a person to go into treatment is by a group confrontation. This must be carefully planned, under the guidance of a trained alcoholism worker. It is useful to have each family member write out and read a list of times and events [involving the person's drinking], which makes the encounter less emotional and more factual. Since they know about it anyhow, small children can have a powerful role to play, as when daddy's girl says, "Why do you drink that stuff when it makes you talk so funny or hurt mommy?" Significant others besides family members may be able to make a useful contribution. The alcoholic will try to play the confronters off against one another. Each must agree to maintain a united front; no one party can feel sorry for the alcoholic and spoil the unanimity. The alcoholic will cry, accuse them of picking on him or her, of being unfair, of exaggerating, etc. But they must promise not to settle for anything less than agreement to enter treatment. It must be explained.

Once detoxification is complete, alcoholics can seek help in many different settings. Hospitals, private clinics, residential facilities, self-help groups, and private medical practitioners all offer programs aimed at helping alcoholics stop drinking. In the United States, it is estimated that each day more than seven hundred thousand people receive medical help for alcohol addiction. By far the largest number of alcoholics seek treatment through outpatient programs. In outpatient programs, alcoholics visit a care center for only part of the day to receive counseling and help in quitting.

Treatment programs almost always include alcohol education classes and some form of group or individual therapy. In individual sessions, only the patient and therapist are present. In group therapy sessions, patients share their experiences, feelings, and concerns with other alcoholics. In both cases, the discussion is usually guided by a trained therapist, sometimes a psychologist, psychiatrist, or counselor.

One of the most important aspects of group therapy is that the alcoholic realizes that he or she is not alone in fighting the disease, that many other people have been struggling for years with the same problem. Jane, a recovering alcoholic, explains how such sessions helped her:

Listening to other people talk about what happened to them, I realized I wasn't the only one who had this problem. There were other people who drank too much and wanted to quit but couldn't. That made me feel better. The most amazing thing was that even though everyone was different, they all had pretty much the same things happen to them, and I could understand just how they felt.⁶⁵

Outpatient programs offer services of varying intensity and duration, some for only for a few hours several days a week. The patient visits the care center for these sessions but does not stay there overnight. All programs try to help alcoholics understand how alcohol addiction works and how to deal with it in their daily lives. Treatment is based on the experiences of recovering alcoholics and the professional staff treating them as well as research on human behavior.

Some treatment centers also prescribe drugs to help people stay sober. One commonly used drug is Antabuse, which reacts with alcohol to make people sick if they drink. Recent research has led to the development of other drugs that can help ease the drinker's craving for alcohol. One such promising drug is Naltrexone, which helps quell both the physical and psychological components of this terrible compulsion.

Although treatment programs vary in the forms of care they give recovering alcoholics, one aspect of treatment is a given for almost everyone: an introduction to the concepts of the self-help group known as Alcoholics Anonymous (AA). This group's principles are universally accepted and taught in alcohol treatment programs, almost all of which recommend that their patients attend AA meetings to stay sober.

Alcoholics Anonymous

AA is based on the simple premise that to stay sober, alcoholics must help other alcoholics. AA was founded in 1935 by two alcoholics who had struggled with their drinking for decades: Bill Wilson, a failed New York businessman, and Robert Smith, an Akron, Ohio, doctor. Wilson, who had been confined to mental institutions and hospitals several times because of his drinking, created AA's twelve steps, which form the basis of the AA recovery program. The twelve steps outline the actions people need to take to quit drinking and learn to live a sober lifestyle.

The first and most important step is for people to admit they are powerless over alcohol and that drinking has created so many severe problems in their lives that they must quit. The other steps include a personal inventory of how they harmed themselves and other people, with an emphasis on how anger, fear, resentment, and selfishness influenced their actions. The alcoholics also list everyone hurt by their drinking and try to make amends. The alcoholic must also work to conquer characteristics that contribute to his or her drinking. The steps are done progressively, but a member of AA is never completely done with any of them. Recovering alcoholics continue trying to understand the steps more deeply and working them more perfectly for the rest of their lives so they can remain sober.

Bill W. and Dr. Bob

The cover of the June 14, 1999, issue of Time is a collage of famous people the magazine considers "Heroes and Icons," including boxer Muhammad Ali, slain President John F. Kennedy, and Mother Teresa. One space, however, was left blank in honor of Bill Wilson, the cofounder of Alcoholics Anonymous. Although famed philosopher Aldous Huxley once called Wilson "the greatest social architect of [the twentieth] century," Wilson always shunned personal publicity out of a fear that it might endanger the organization he helped create. Wilson asked the media to refer to him as "Bill W.," and Robert Smith became "Dr. Bob." A story in the magazine by novelist Susan Cheever, herself a recovering alcoholic, explains how AA got its start after the two men met.

Five months [after quitting drinking], Wilson went to Akron, Ohio, on business. The deal fell through, and he wanted a drink. He stood in the lobby of the Mayflower Hotel, entranced by the sounds of the bar across the hall. Suddenly he became convinced that by helping another alcoholic, he could save himself. Through a series of desperate phone calls, he found Dr. Robert Smith, a skeptical drunk whose family persuaded him to give Wilson 15 minutes. Their meeting lasted four hours. A month later, Dr. Bob had his last drink, and that date, June 10, 1935, is the official birth date of A.A., which is based on the idea that only an alcoholic can help another alcoholic. "Because of our kinship in suffering," Bill wrote, "our channels of contact have always been charged with the language of the heart."

The heart of the AA program is a belief that alcoholics need the help of a "higher power" to quit drinking and transform their lives for the better in many other ways. AA, however, is not a religious program. It is not allied with any specific religious group, and its members include Catholics, Protestants, Jews, and members of other major religions. The pamphlet Forty-four Questions explains that AA only asks that its members believe in a higher power as they understand it:

Most members, before turning to A.A., had already admitted that they could not control their drinking. Alcohol had become a power greater than themselves, and it had been accepted on those terms. A.A. suggests that to achieve and maintain sobriety, alcoholics need to accept and depend upon another Power recognized as greater than themselves.⁶⁶

AA members are urged to develop a one-on-one dialogue with the higher power of their choosing. To make themselves strong enough to stay sober and lead better lives, AA members maintain this vital link to their higher power by daily prayer, inspirational readings, and meditation.

How AA Works

Alcoholics Anonymous began after Wilson and Smith met in Akron and began talking to each other about how alcohol had ruined their lives. Since that time, Alcoholics Anonymous has grown into a worldwide organization that operates in 150 countries and has over 2 million members. Its strength still comes from the simple principle that alcoholics must help other alcoholics in order to stay sober. The best description of this is from the preamble that is usually read before each AA meeting:

Alcoholics Anonymous is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism. The only requirement for membership is a desire to stop drinking. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.⁶⁷

Anyone who believes they have a drinking problem can attend meetings, which usually last one hour and generally include readings from Alcoholics Anonymous or other literature. There are no dues or fees for membership in AA, although people usually make a small voluntary contribution when they attend meetings to cover incidental costs such as renting a room and serving coffee.

The most important part of the meeting, which is similar to group therapy, is when members have a chance to explain how they are staying sober, comment on one of the steps, or simply talk about something that is bothering them. This sharing, as it is called, helps others realize they are not alone in battling alcohol, provides them with the hope that they can stay sober, and shows them ways that other people have managed their sobriety.

Alcoholics Anonymous has proven to be the most effective long-term form of treatment for alcoholism. In fact, AA has been so successful in helping alcoholics that its twelve steps have been adopted by groups fighting many other addictions, from narcotics abuse to overeating. The Columbia University College of Physicians and Surgeons Complete Home Medical Guide claims,

Alcoholics Anonymous and its subgroups—Al-Anon for family members of alcoholics and Alateen for teenage children of alcoholics—are self-help organizations that provide experienced advice and support for alcoholics and their families. Most experts recognize A.A. as the core of any alcoholic therapy.⁶⁸

Relapse

Neither AA nor any other program can help everyone. And for many alcoholics, the battle to quit can be a long one, with both victories and defeats. When an alcoholic resumes drinking it is called relapse. And relapse is common, even for people who have been hospitalized several times in their fight to stop. Author Arnold M. Ludwig says staying sober is difficult because the craving for alcohol results in people making excuses that justify drinking:

The alcoholic's worst enemy is not the bottle but his own mind, within which is the ever-present Trojan horse of desire, waiting to smuggle in the enemy when the defenses have been lulled into complacency. What must be recognized is that in this case the brain is much less an organ of rationality than of rationalization. His mind tries to legitimize his intentions and behaviors so that he need not feel guilty. So that he can convince himself that he is making the right choice.⁶⁹

In addition to the internal struggles and cravings that often rage in the minds of alcoholics, many social pressures can entice people to drink again. Sometimes promptings from friends or family members who have their own problems with alcohol are all that is needed to start someone drinking again. Nicholas A. Pace of New York, an assistant professor at the New York University School of Medicine, says that to stay sober, people need to make drastic changes in their lives, including changing with whom they socialize:

Patients need to examine their drinking or drugging lives carefully to decide what situations may have stimulated them to use. Maybe they'll find that every time they went to visit their mother they got into an argument and started to drink. If that's the case, it's probably not such a good idea for them to visit their mother in early sobriety or until they've worked with a therapist through the issues that cause these arguments. Like they say in A.A, stay away from or avoid the people, places and things that are going to remind you of drinking.⁷⁰

Sobriety Success

Alcoholism treatment is helping more alcoholics today than ever before to quit drinking. The Tenth Special Report to the U.S. Congress on Alcohol and Health, issued in 2000 by the National Institutes of Health and the NIAAA, states, "Treatment outcome studies have repeatedly found large and sustained reductions in drinking among persons seeking help for alcoholism."⁷¹

Treatment does not help everyone, however. It is generally believed that out of one hundred people in addiction treatment, about a third will quit, another third will reduce their drug use, and the remainder will continue using drugs or drinking. Alcoholics Anonymous is the most successful long-term recovery program. But even AA estimates that only 10 percent of alcoholics ever attend a meeting and only about 10 percent of those remain sober more than three months before relapsing. These figures suggest that alcoholics can stop drinking, but not without a great deal of effort and determination.