EVALUATING ALCOHOLISM AND ALCOHOLISM TREATMENT

July 10, 2017. Jacob ben Abraham.

WHAT SORT OF PEOPLE BECOME ALCOHOLICS?. When I hear people imply that alcoholics are stupid, irreligious, of bad character or lazy, I think first of my Father, the first alcoholic I knew. He was also one of the kindest and bravest souls I have known. He was an outstanding student in his college career, popular with his peers. I do not know of him ever saying anything he knew to be untrue. He worked hard from before eight A.M. until after 6 P.M. six or seven days every week except for very short vacations every year with his family. But there were clusters of days when he was too intoxicated to leave the house. He read his Bible and usually some religious study material every morning before breakfast, attended church faithfully, was the superintendent of the church Sunday school for many years, and organized our small town’s interdenominational Easter Sunrise service. Everyone who knew him found him likeable and trustworthy.

My father’s will power seemed almost superhuman sometimes. He did whatever he said he would do—except stop drinking and stay stopped. He often said that he was through drinking. Those who were close enough to know the misery he suffered as the result of his binges knew he meant what he said. We also knew that his resolve would soon dissolve in another round of heavy drinking. He could not stay sober very long. When he was not at work he was at home either passed out or drinking enough bourbon to pass out soon.

I soon found out that my Father’s situation was extremely common. There happened to be a large mental hospital in my home town. On several occasions I overheard conversations on this subject among doctors and other staff members. On one occasion I had a long talk with a medical doctor who had many years of experience with trying to be helpful to people with serious drinking problems. What I learned was that alcoholism was a very widespread problem. It often afflicted very capable people who were otherwise morally upright and strong willed. Studies involving huge samples had shown that alcoholism is not predictable by low morals or intelligence.

Mr. Abraham Lincoln, speaking to the crowd assembled in February 1842: “If we take habitual drunkards as a class, their heads and hearts will bear an advantageous comparison with those of any other class. There seems to have been a proneness in the brilliant and warm-blooded to fall into this vice—the demon of intemperance seems to have delighted in sucking the blood of genius and generosity.”
Like Lincoln I have always known that the popular notions about the foibles of drunkards are off the mark, although they have remained popular since humans first wrote about the tragedy of those who cannot “hold their liquor”. Over three quarters of a century I have searched long and hard for the answer to the simple question “What does cause some folks to be alcoholic while most who drink never develop the terrible problems that all alcoholics have in time—including early death?” So far I have not found a satisfactory answer to the question. There have been massive studies of British data which confirm Lincoln’s observation. Smaller studies of alcoholics in the U.S.A. report that alcoholism cannot be correlated with pre-morbidity differences in people who later become alcoholics. Childhood and adolescent subjects are not more likely to have drinking problems because of differences from their peers in intelligence, generosity or sociability. In fact as a group the more positive outcomes of those studies lie with the pre-alcoholics.

Now that would not be such a painful conundrum if I could have found the solution to the problem. I have not done that either.

TREATMENT DOES NOT SOLVE THE PROBLEM. In 1975 the JOURNAL OF STUDIES ON ALCOHOL published the following verdict on psychologically oriented treatment of alcoholism:

“A review of 384 studies of psychologically oriented treatment showed that differences in treatment did not significantly affect long-term outcome. Mean abstinence rates did not differ between treated and untreated alcoholics, but more treated than untreated improved, suggesting that formal treatment at least increases the alcoholic’s chances of reducing his drinking problem.”

Since then there have been hundreds of new treatment programs launched, including some that have gained more than a little publicity for treating famous drug addicts and alcoholics. The British have published massive studies of effectiveness based upon their national health care program’s results. At least one per decade. Columbia University in New York has conducted a scholarly review of the available evidence in the United States. All of these studies have found the same results as the 1975 study quoted above. Alcoholism remains statistically the same. Abstinence achieved is rarely maintained, although those lucky enough to receive frequent stays in treatment programs often are found to be sober more often for a while (at least while in treatment and sometimes for short times after). Permanent abstinence is as rarely achieved by alcoholics who never go to treatment as those who do. The sooner public policy recognizes that both the problem’s genesis and solution remain mysteries to the honest. Sadly both also remain the subject of widespread false analysis and representation.

Comments are encouraged, though your first one on this blog must be approved by blog author before it appears. Thanks!