Understanding and Counseling the Alcoholic by Howard J. Clinebell, Jr.
Howard J. Clinebell, Jr. Is Professor of Pastoral Counseling at the School of Theology at Claremont, California (1977). He is a member of the American Association of Marriage and Family Counselors, and the American Association of Pastoral Counselors. He is a licensed marriage, child and family counselor in the State of California. His personal website is http://members.aol.com/clinebellh/index.htm, and his email address is clinebellH@aol.com. This book is the Revised and Enlarged Edition published by Abingdon Press, Nashville, 10th Printing, 1990. Used by permission. This material ws prepared for Religion Online by Richard V. Kendall.
Chapter 3: How Religion Has Been Used to Help Homeless Alcoholics
It is possible to learn a great deal about helping alcoholics by studying and evaluating the major religious approaches to the problem. One can profit by both the successes and the failures of those religious groups whose primary concern has been helping alcoholics. This is the purpose of the chapters immediately ahead. Three different religious orientations will be studied and compared: (1) the evangelistic-authoritarian approaches of the rescue mission and the Salvation Army; (2) a psychologically oriented approach, the Emmanuel Movement; and (3) a permissive, self-help approach, Alcoholics Anonymous. We will begin in this chapter with the evangelistic-authoritarian approach which has been used chiefly with low-bottom, homeless alcoholics.
Before proceeding, it might be helpful to the reader to indicate more directly the relevance of the next three chapters to the work of the pastor and others who are concerned with helping alcoholics. This present chapter will obviously be of greatest interest to those who work in downtown, urban churches where such alcoholics most frequently are encountered. The broader significance of the chapter lies in whatever light it throws on the psychological understanding of authoritarian religion in general. Chapter 4, dealing with the Emmanuel Movement, is of special interest to those who are concerned, as many clergymen are, with helping to develop a closer relationship between religion and psychotherapy, both in general and in the treatment of alcoholism. Chapter 5, the AA chapter, will have the most direct relevance to the work of the average pastor, since AA is his most valuable and effective referral resource. The more extensive coverage of this chapter is justified by the fact that a pastor needs to have as full an understanding as possible of this movement.
Understanding the Homeless Alcoholic
A Skid Row can be found in almost any American city. In Chicago it is West Madison Street; in Los Angeles, Fifth Street off South Main. San Francisco has its Howard Street. In New York it’s the Bowery. These and dozens of smaller counterparts are the "streets of forgotten men," stagnant catch-basins which collect the dregs of our social system. In such blighted areas one finds a high concentration of low-bottom alcoholics, men who are "on the bum."
A visit to the Bowery on New York’s lower East Side reveals a run-down street, no longer canopied by the metallic arms of the Third Avenue El but still lined with noisy dives, cheap flophouses, pawnshops, used clothing stores, and rescue missions. In the warehouse doorways ragged, vermin-infested men lie in alcoholic oblivion. A huddle of disheveled, unshaven individuals talk raucously as they pass about a bottle of "Sneaky Pete" -- cheap wine fortified with rubbing alcohol. Human derelicts wander aimlessly up and down the street, milling together like swarming insects. Two, in the belligerent stage of drunkenness, shout curses and exchange blows. A crowd gathers to watch. Every few feet "plingies" (Bowery slang for panhandlers) ply their trade, begging from all likely prospects who pass. Up "Dead Man’s Alley" a "squeeze" is in progress -- Sterno is being warmed over a fire of newspapers preparatory to squeezing it through a sock to make a drink called "Pink Lady." As one watches the scene, the words of a young alcoholic come to mind. Out of his own tragic experience he described the Bowery as "this dirty, dead trail of a thousand broken dreams in a thousand broken minds and bodies." 1.
‘Who are these men, and how do they manage to stay alive under such conditions? Sociologically they are classified as homeless. Fortunately, several extensive studies of homeless men have been made by the social scientists.2. One of the most useful is the study made by sociologist Robert Straus.3. By means of interviews, Straus studied the cases of 203 homeless men who came to the Salvation Army social service center in New Haven, Connecticut, in 1946. Let us review some of his findings.
The typical homeless man left his parental home at an early age, often following the death of a paront or serious conflict in the home. Early emotional instability and deficient socialization are characteristic. He stopped his education between the seventh and eighth grades. He has usually either never married or is widowed or divorced. He is constantly on the move, going from one Skid Row to another and rarely staying in one place more than a few weeks or months. Religiously he is either Catholic or Protestant, almost never Jewish. Concerning attitudes toward religion, Straus reports: "Nearly all of the men spoke of their religion in the past tense.~ They felt that they had lost touch with their faith, expressed little interest in church attendance." 4.
Many of them are unemployable. Others work at various unskilled or semi skilled jobs for part of the year and are on the bum the rest.
Are these men homeless because they are alcoholics, or are they alcoholics because they are homeless? Straus found that heavy drinking preceded and seemed to be a contributing cause of homelessness in two thirds of the men. In the other third, heavy drinking followed and seemed to result from the condition of homelessness. He concludes: "Drinking seemed to be one of the several causes or one of the several results of homelessness."
It is important to remember that homelessness is in itself a pathosocial condition, that homelessness and alcoholism often arise from the same causative factors, and that each condition tends to enhance the other. For the person whose ability to relate meaningfully to others has been impaired by early emotional deprivation, alcohol and homelessness are two ways of escaping the pressures of adult interpersonal demands. It is when living closely with others becomes unbearably painful that one retreats into homelessness, a life that demands almost nothing of the person. But homelessness removes not only the responsibilities but also the satisfactions of normal living. A homeless man -- drifting and rootless -- has almost no motivation for abstaining. The more he becomes divorced from normal life, the more he must resort to the pseudo-satisfactions of alcohol. Thus a vicious spiral of homelessness and alcoholism is established.
In 1958 sociologists David J. Pittman and C. W. Gordon reported on a study of 187 "chronic police case inebriates." 5. These are low-bottom alcoholics who are constantly in and out of jail as a result of repeated drunkenness-related arrests. They constitute a sizable portion of the Skid Row population. Pittman and Gordon summarize their findings concerning this type of alcoholic.
Our study has shown him to be the product of a limited social environment and a man who never attained more than a minimum of integration in society. He is and has always been at the bottom of the social and economic ladder: he is isolated, uprooted, unattached, disorganized, demoralized and homeless, and it is in this context that he drinks to excess . . . he is the least respected member of the community. . . . He never attained, or has lost, the necessary respect and sense of human dignity on which any successful program of treatment and habilitation must be based. He is captive in a sequence of lack or loss of self-esteem, producing behavior which causes him to be further disesteemed. Unless this cycle is partially reversed, we doubt that any positive results can be attained. 6.
It is pathetically significant that over 90 percent of the men in the study had had no systematic treatment.
The Skid Row existence provides a kind of solution or adjustment for those who live there. Alcohol is the major ingredient of this solution.
Heavy drinking is regarded as normal, and the occasional abstainer is viewed with suspicion. Many of Straus’s interviewees said that alcohol provided them with congenial companions and, in their present situation, let them forget their lack of possessions and status. Alcohol also serves as an alibi. When they are confronted by criticism or remorse, they point to the fact that they are afflicted by the unfortunate drink habit. When one sees the variety of ways in which alcohol is a form of adjustment for homeless men, it is possible to understand why a majority of those interviewed said they had no desire to stop drinking.
This does not mean that all Skid Row inhabitants are satisfied with their lot. Dressed in old clothes, the author spent an evening mixing with the men on the Bowery. Again and again they indicated their dissatisfaction. One inebriate advised: "Listen, Slim, don’t hit this street like I did." A seaman said, "I’m just waiting until I can get off this binge and back on a ship." Even though many are not satisfied with their solution, it is the only one of which they see open to them. Their dissatisfaction is outweighed by the temporary rewards of alcohol and homelessness.
The fellowship of the Bowery -- a fellowship made possible by alcohol -- is another ingredient of this solution. This is a special kind of fellowship; one can participate or withdraw at any time. The Bowery has its unwritten code, its slang, and its newspaper -- The Bowery News, The Voice of Society’s Basement. Little groups of men band themselves together for the purpose of obtaining a constant supply of alcohol. Their common need is the bond that unites them.
There are other elements in the Bowery solution. The flophouse, known colloquially as the "scratch house," makes the Bowery the cheapest place in the city to rent shelter. However, if a choice between a flop and a bottle is necessary, the flop rates a poor second. Sleeping indoors is a luxury -- alcohol a necessity. The ambulance from Bellevue Hospital is an element in the Bowery solution. The city hospital is to the homeless alcoholic what the sanitarium is to the solvent alcoholic. When injured by a "jackroller" -- one who makes his living robbing them when they are drunk -- or suffering from alcoholic delirium, the Bowery alcoholic is taken to Bellevue, the city hospital. ‘When released, his first stop is usually the nearest gin mill. The "dead wagon" from the city morgue makes regular visits to the Bowery. After a cold night it goes about its grim business of collecting the newspaper-covered remains of those who were too drunk or too unlucky to find shelter.
Many of the men on the Bowery have gone far beyond the "bottom" described in Chapter 1. The spiral of progressive alcoholism has swirled down ward through years of deterioration. Many of them have one of the diseases of chronic alcoholism -- polyneuropathy, pellagra, cirrhosis of the liver, or others. However, many of the men on Skid Row are not in such a condition.
A study made in Seattle 7. showed that many Skid Row alcoholics are not in the final stages of their drinking careers. Some have just arrived. Others are there only temporarily and will leave when they are arrested or meet some other crisis. It is obvious that the possibility of helping this type is much greater than in the case of the deteriorated alcoholic.
The heterogeneity of the Skid Row population is an important consideration which has a bearing on both prognosis and treatment methods. Thomas B. Richards, an experienced worker with homeless alcoholics, states that for some the possibility of rehabilitation is minimal or nonexistent because of advanced alcoholic deterioration. For these, what is desperately needed is humane custodial care. According to Richards, the largest group of Skid Row alcoholics consists of those for whom rehabilitation is a realistic possibility. Many of these are in the younger age group. They are employable though largely unskilled occupationally and irresponsible in their life-styles. Thus, they are not beyond the possibility of restoration to a socially constructive life. 8.
The Pittman and Gordon study identified several different types among chronic police case inebriates: the mentally disturbed characterized by a general pattern of criminal behavior; the older offender, with no criminal involvement (except for a few arrests for public intoxication), whose main problem is his physical decline which makes him much less employable; and the Negro inebriate, often a recent migrant from a southern rural en vironment to the cities of the North and West, a person with no training and very unfavorable employment opportunities. 9.
It is with the various kinds of homeless men that the two hundred rescue missions on Skid Rows over the country do their work. The missions, too, are a part of the Bowery solution. At the very least they offer a bowl of soup, opportunity for delousing, and a warm place to sleep in winter. Beyond this, they hold out promise of release, salvation, and a blissful hereafter.
The Rescue Mission Approach to Alcoholism
A raw wind is whipping up the street as we pause in front of the mission. Here is a five-story, stone building on which a large neon sign blazes forth the name of the mission. Smaller signs read: "A Friend to the Friendless"; "Free Facilities in the Basement, Clothing, Washing, Mending, Shaving, Shower Bath, Fumigation"; "Gospel Meeting Every Night, 7:30." As one enters the chapel, one immediately notices the characteristic atmosphere of blended body odor and alcohol. The organ plays old hymns. The chapel is nearly full. Here and there a man scratches vigorously; others doze in alcoholic slumber. Behind the back pew is an array of paper sacks and bundles tied in dirty newspaper. The worshipers have deposited their worldly possessions for the duration of the service. Over the pulpit at the front is a dark blue banner on which bright yellow and red letters proclaim, "Jesus Saves." One looks at the faces of broken and defeated men. Eyes stare in cold, bloodshot cynicism.
The organist has stopped playing, and the evangelist begins to pray, asking God to reveal the proper hymn with which to begin the service. The prayer ended, the hymn "Nearer the Cross" is announced. Singing by the congregation is spotty. Another gospel song follows. Then a young lady evangelist testifies in song with the selection "It Is Well with My Soul." After a heartfelt rendition of the solo she asks rhetorically, "How about your soul, friend? Is it well with your soul?"
The leader of the service steps to the pulpit and says, "The important thing is to stop trying to do things in your own strength and let Christ take full possession of your life. Christ -- he’s the best friend we have." The congregation then sings, "What a Friend We Have in Jesus." The leader tells how he was saved from a life of gambling, alcohol, and sin. Several recent converts then testify. The leader then invites testimonies from anyone who wishes to tell what Christ has done for him. A sprinkling of short testimonies comes from the audience. One grateful man stands near the back and says, "I thank God that I can say through the blessed blood of our Lord Jesus that I’m sure I’ll meet my dear mother in heaven."
After the testimonies the leader begins his message which includes the following:
I feel led to discuss the two highways -- the broad road that leads to hell and destruction and the narrow highway that leads to heaven and eternal life. We get on the highway of righteousness only by the Lord Jesus, the way of the cross -- he is our guide who takes us by the hand. Christ bridged the great gulf separating the two highways and therefore can snatch you from the highway of destruction over to the highway leading to heaven. Come to Jesus and say, "Lord, I’m a sinner," and he’ll get you across the great chasm. I beg you, heed the word of God. Some of you are waiting to die, but it’s not over then! The way of destruction goes directly into hell! (A tremor appears in the speaker’s voice.) Put your sins under his blood. I have no fear when I die -- my loving Savior will meet me and take care of me. Can you say, if the Lord calls you today, "Goodbye, world; I’m glad to leave the world and go to be with Jesus"? Can you say that and know that you will?
The message is followed by the invitation period. The congregation is led in prayer. While heads are bowed, those who wish intercessory prayer on their behalf are asked to "slip up their hands." The leader encourages response by recognizing the hands that go up -- "There’s one in the back." "I see your hand over on the side, brother." Then a hymn, "Almost Persuaded," is sung. Between each stanza the invitation to come forward and be saved is repeated. The wonderful blessings of "answering God’s invitation" are presented with increasing emphasis, as are the awful consequences of refusing. The leader tells a story about a former crony on the Bowery who postponed coming to the altar one night too many, was hit by a truck, and "went to a Christless grave!" Pointing at his audience, the leader asks, "Are you ready for heaven?" When "Almost Persuaded" is exhausted, "Jesus Is Calling," another invitation hymn, is announced. Old emotions are stirred as the leader describes the death of his mother. While this is going on, former converts canvass the audience, "fishing" for converts -- those "almost persuaded."
Those who respond to the invitation and go forward have a worker who kneels beside them to help "pray them through." The worker tells them how Christ saved and cleansed him, and helps the penitent to say a prayer, how ever short or faltering. If the procedure is successful, the penitent experiences a powerful emotional experience of forgiveness, release, and exaltation. The altar call, or invitation, usually lasts about fifteen minutes, but it may go on longer if a substantial number have not been converted.
The essence of the rescue mission approach to alcoholism is contained in one word -- salvation. Salvation, in mission thinking, consists of the kind of religious experience described above. To produce this experience is the goal of all mission activities. These activities may be divided into two categories:
(1) the religious services including the gospel meeting such as was described, and smaller prayer meetings; (2) the work of physical and social rehabilitation.
The gospel meeting is the heart of the mission program. In order to receive food or shelter, a man usually must attend the religious meeting first. After the meeting the congregation files silently downstairs for supper consist ing of soup and bread. After supper those who can be accommodated are given cots on which to sleep. Next morning they may shave and shower. After breakfast the converts of the previous evening are interviewed briefly by a mission worker, himself an ex-alcoholic. The worker asks a few questions about the convert’s employment record and intentions. If a convert seems to offer possibility of permanent recovery, he is assigned to a bed and locker in one of the dormitories. Before he sleeps there he must be fumigated. He may be invited to stay at the mission until he can get back on his feet, but he is free to leave if he wishes. He may receive used clothing and, if he needs it, medical attention from the part-time clinic maintained at the mission.
If the convert decides to stay at the mission, it becomes his "home" for a while. He may be assigned work to do around the mission and, when he is recovered enough to be able, sent out on small jobs obtained by the mission’s employment service. He is expected to attend Bible study, prayer, and gospel meetings. After a few days he will be asked to testify at a meeting. Members of the mission staff are available for counsel. Thus his conversion experience is solidified and strengthened. After several weeks of testing the convert may be transferred from the mission itself to the "Home Uptown," a house where about twenty converts who seem to be making the grade are allowed to go. Here he will have a room of his own and a closet for his clothes. More important, he now has an address that has no stigma attached. He is off the Bowery. From here he seeks employment, often helped by the mission. In some cases the mission staff will help effect a reconciliation between the convert and his family. The goal of mission therapy is to eradicate homeless-ness as well as alcoholism. This is based on the realistic recognition that as long as a man stays on the Bowery his chances of recovery from alcoholism are very small.
Some rescue missions maintain fellowship groups for ex-alcoholics. Alcoholics Victorious, which was founded at the Chicago Christian Industrial League, is one of these. This fellowship now has chapters in rescue missions in various cities. The groups hold weekly meetings at which the men give testimonies, discuss personal problems, and help each other. Only alcoholics can belong. The creed of Alcoholics Victorious is somewhat comparable to the Twelve Steps of the AA program, except that it has a fundamentalistic Christian language and orientation.
The Psychodynamics of Mission Therapy
How does the mission approach operate psychologically? The gospel meeting and rehabilitation can be analyzed in terms of four stages: preparation, crisis, surrender-acceptance, and consolidation.
It is necessary to prepare the individual for the emotional crisis experience which produces sobriety in some cases. There are several reasons for this. The mission clientele is composed largely of men who have little desire to stop drinking. Crises or "bottoms" during which the nonhomeless alcoholic is relatively accessible to help are, for many of these men, experiences of the past. They have, so to speak, used up their "bottoms" without finding help. We are dealing with the psychology of the realm beyond remorse and despair. It is necessary to revive these stuporous emotions if a crisis is to be induced. Preparation is also necessary because of the fact that, as Straus discovered in his study, most of them look with contempt on the very missions from which they receive food, clothing, and shelter. Religious services are something to be endured in order to get a much needed flop or a bowl of soup. Unless this negative attitude can be changed, it is unlikely that the alcoholic will respond in the way desired by the mission.
Group singing is of first importance in preparing the alcoholic for conversion. Studies in the psychology of music have shown that rapid, loud, rhythmic group singing of songs that stress the repetition of a few simple ideas tends to produce lowered inhibition, enhances suggestibility, a sense of group-ness, emotionality, and a tendency toward impulsive action. 10. Under the influence of a rapidly moving revival atmosphere, punctuated by the singing of the simple, primitive music of the gospel chorus, the defensive shell of the alcoholic is gradually softened. He begins to feel more a part of what is going on. Then, too, the singing of old salvation hymns may awaken long-forgotten emotional associations from the early life of the individual. A convert recalled: "I didn’t think much of the service at first. But when they sang ‘Jesus, Savior, pilot me over life’s tempestuous sea,’ it struck a spark somewhere. We used to sing that at home around the piano." 11.
Personal testimonies are a powerful form of preparation. The testifiers describe themselves as having lived on Skid Row and tell of their sins and degradation. This helps the derelict to identify with them and to listen to what they say. There is a strong element of positive suggestion in the participation of testifiers scattered throughout the audience. This participation helps mold the aggregate of individuals who enter the chapel into a unified pliable group. ‘What is more, the testimonies may awaken a glimmer of hope -- "Maybe there’s a chance I can do it too."
The man in the mission pew is assailed by a barrage of emotionally charged illustrations and ideas which serve to reactivate his slumbering fear and guilt. Frequent mention of home and mother serves to awaken memories of life prior to the homeless state. Lurid threats of eternal punishment are sprinkled through mission sermons and interviews. One mission superintendent quoted the counsel he had given to an unconverted man: "I told him, ‘Unless you accept the Lord, you’re on your way to hell! You’ll burn! You’re still a little green, but you’ll burn -- not just smolder. Jesus said you must be born again
-- not may but must!’"
What might be called the "moralistic assumption" -- that the alcoholic is completely responsible for his despicable condition -- underlies all mission thinking and speaking. Alcoholism is a sinful habit acquired by the sin of using alcohol. This conception has stood unshaken from the days of Jerry McAuley, the "father of rescue mission." 12. A revealing encounter with AA ideology was described to the author by a mission employee: "A fellow from AA came in claiming that alcoholism isn’t a sin but a sickness. I opened God’s Word to I Corinthians 6:10 and Galatians 5:21 and proved to him that it was listed by God as a sin along with murder and stealing." Alcohol is the cause of both alcoholism and homelessness, according to mission thought.
By pressing the moralistic assumption the mission evangelist makes a head-on attack on the alcoholics’ defenses. By stimulating his guilts and fears
under the influence of group emotion, the evangelist is able in some cases to crack his defensive alibi system. When this happens, the individual is exposed to his real feelings of self-disgust. He is made to feel as miserable, hopeless, and helpless as possible. While his body is wracking from the physical effects of prolonged inebriety, the Bowery technique has created a "bottom," an emotional crisis, in which the alcoholic is open to help.
Into the emotional chaos and gloom a shining hope is projected. There is a way out! The sinner can do nothing for himself, but there is a Savior who cares. All the person must do is to accept this wonderful Savior and salvation will be his. Here is the pressure of opposites -- eternal punishment or supreme beatitude.
Straus has pointed out that effective therapy for homeless alcoholics "must offer substitute reward values for abstinence which will be at least equivalent to the reward value of excessive drinking and which will not require greater effort than is required by drinking." 13. "Salvation" measures up on both scores. It requires only a decision. God does the rest. It is quick and effortless. It carries the rewards of acceptance and dependency. The alcoholic has but to surrender to God and he will be taken care of. For the lonely, emotionally starved alcoholic this kind of dependency carries great appeal.
The religious experience itself is another reward. If the person has been caught up in the proceedings -- the rhythmic singing, the testimonies, the fervent prayers, the appeals to fear, to guilt, to memory, to hope, to dependency -- in short, if he has felt the thrill of a pulsating religious group, he has found a substitute value for alcohol. Religious ecstasy provides another path to the feelings of expansiveness and larger life formerly achieved by alcohol.
The altar call is a masterpiece of positive suggestion. The various psychological pressures of the evening are recapitulated. Then follows the opportunity for a series of positive responses, in which the person moves from a small to a larger and larger "yes." The first is merely raising the hand when heads are bowed to request prayer. This intercessory prayer in itself has a powerful influence in that it focuses the feeling of divine attention on the individual. Then the leader may ask for those who want to be saved to raise their hands. As hands go up, he repeats the "nest egg" stimulus of "Thank you. Yes, brother. Three more back there." The third positive response is that of actually going forward. A hymn suggesting this response is sung (e.g., "Just as I am. . I come, I come"), and all stand. The fact that everyone is standing makes it easier to get started to the front. The resistance of those who are wavering on the line is worn down by repetition and by personal invitations from those who are "fishing" for converts.
When a person does go forward (and does so sincerely), he has already taken a tremendous step. For this action means that he is motivated strongly enough to defy the opinion of his cronies who look with scorn on those who "take a dive for Jesus," and that he has relaxed his own defenses for the moment and is asking for help. The individual attention of the worker who helps "pray him through" plus the act of actually asking help from God often bring the man to a conversion experience.
It is impossible to describe fully the powerful religious experience which takes place in the convert. Those who attempt to put it into words tell of sudden release from guilt, of inner cleanness, of wonderful elation. They tell of feeling "back home" after years of spiritual wandering. Some tell of sudden release from the craving for alcohol. After his conversion Jerry McAuley told of feeling that "life was all new."
It would seem probable that it is the emotional intensity of such an experience which melts the alcoholic’s shell of defenses and opens him to help. It is apparently the combination of the fear-guilt crisis with the offer of supernatural help which produces the surrender. The conversion experience would seem psychologically analogous to the following: A child who has been rebelling against parental authority finds the estrangement unbearable; he rushes back into the parent’s arms. The parent accepts him, and the child feels a wonderful euphoria. He is accepted by the authority upon whom he is dependent. The parent will take care of him, and he will obey the parent. The alcoholic who experiences salvation is no longer fighting authority. He feels accepted.
The mission structure provides an environment in which the conversion experience may be consolidated. The dependence on an Almighty Power is buttressed and symbolized by concrete dependence on the mission workers and on the physical surroundings. His food and shelter are tangible evidences of the mission’s parental care. For the shaky new convert the mission organization provides a closely knit "in-group" where he is both accepted and needed. It is through his experiences in the religious group that his religious experience is consolidated. He learns the mission vocabulary. He is a member of an exclusive fellowship, the "saved" as distinguished from the great unwashed. Continued membership depends on compliance with its moral demands. One of the demands is abstinence, a by-product of salvation. The "born-again" Christian turns from worldly vices. Abstinence is rewarded -- by God and by God’s group. Social controls are reestablished. As one of the saved the convert is uniquely empowered to save others. We know that most alcoholics resent dependency. The shift from "helped" to "helper" is therefore essential to the consolidation and continuance of the religious experience. In addition, the new role provides an outlet for unresolved hostilities and aggression, turning these energies toward sin and sinners. The convert now has a group approved channel for his negative feelings.
How Effective Is This Approach?
It is the assumption throughout this book that no analysis of a religious phenomenon can be complete which omits the creative power of God. All healing depends on this power. This power is equally available to all religious approaches to alcoholism. Yet some are more effective than others. The question then is this: Why is one religious approach more or less adequate than another as a channel for the healing forces which are available in the universe? More specifically, how effective is a given approach in utilizing religious re sources to produce and maintain sobriety?
The available evidence suggests that the mission approach is often effective in producing initial sobriety by arresting the "runaway symptom" aspect of alcoholism. For the year ending August 31, 1951, the mission described re ported 5,824 "professed conversions." 14. Implied in the word "professed" is the recognition that not all conversions are sincere. One alcoholic interviewed told of drawing match sticks to see who was going to be saved so that the meeting would end and the food be served. Then there is the "mission stiff," a man who lives for years by exploiting one mission after another, becoming very skillful in going through the motions of a conversion. Even if one makes generous deductions for these phony conversions, there is still a sizable group which responds sincerely to mission therapy. This supposition is supported by those who have had extensive firsthand experience with missions. For example, a member of AA whose attitude toward missions was sharply critical admitted, "A hell of a lot are sobered up at such places."
When one considers the total number who attend mission meetings, the percentage of conversions is probably very low. Obviously many homeless alcoholics do not respond to mission therapy. The use of food and shelter as "bait" to get the alcoholic into the service enhances his negativism and resentment of religious institutions, making it more difficult to reach him with religious help. Further, the moralism of the mission in many cases stimulates the alcoholic’s hostility and defensiveness rather than his sense of responsibility. Instead of cracking his defenses, the direct attack on him merely makes him more rigid. The attitude of general resentment toward missions, which exists on the Bowery, is in part a reaction to the battering of his ego-defenses to which the alcoholic must expose himself at the missions.
The mission conceptions of alcoholism and homelessness are grossly in adequate, overlooking nearly all that the social sciences have to tell about these two phenomena. The naïve moralism in this area can be maintained only by ignoring the facts that inebriety is as much a symptom as a cause of the disturbed interpersonal life of the alcoholic, that alcoholism is a complex disease involving physical, cultural, and socio-psychological as well as moral factors, and that homelessness is in itself a complex phenomenon, not the simple product of excessive drinking. The mission conception of the human situation -- the nature of sin, free will, and responsibility -- as it relates to alcoholism is philosophically and psychologically inadequate. If depth psychology has demonstrated anything, it has shown that human behavior, and especially neurotic behavior, is never simply a matter of freewill choosing between alternatives. Every act is conditioned by early life experiences which shaped the personality, by environmental factors in the present, and by historical contingencies. Untrammeled free will, in the sense that it is used in mission thought, does not exist. The concept is especially inapplicable to alcoholics. The more neurotic a person is, the more his actions are controlled by inner compulsions and the less freedom of choice he has.
It is the author’s belief that many alcoholics sense, however vaguely, that their problem is not simply a matter of moral failure. The mission’s treatment of their problems as moral derelictions must drive many alcoholics away from help by conveying a complete lack of understanding.
The mission’s exclusivistic attitude toward its own approach lowers its level of initial effectiveness. Believing as it does that there is only one valid approach to alcoholism, it ignores the therapeutic resources available in psychotherapy, AA, and medicine. In a problem as complex as alcoholism this myopic view is particularly unfortunate.
What percentage of the alcoholics who receive initial sobriety are able to achieve long-term sobriety through this approach? It is impossible to cite reliable statistical evidence, for, as a mission staff member put it, "God keeps the records." Any mission can produce a group of cases of individuals who are known to have remained abstinent over a period of many years. But no one knows what percentage of the daily converts remain abstinent for a week, a month, a year, or for five years. Indications are that the percentage of long-term abstinence is low.
The fundamental reason why mission-induced sobriety is often impermanent is that homeless alcoholics are very difficult to help by any means. Beyond this, however, it is undoubtedly true that, in many cases, this approach does not deal with basic causes. Symptoms are shuffled -- compulsive religion replacing compulsive drinking. Alcoholic converts often give one the impression that their solution is decidedly brittle -- that they must keep very busy saving others or their own solution is likely to collapse. Too much fear and repression of negative feelings are employed. Too little self-understanding results from the experience. In many cases, the individual’s basic problem, surface changes to the contrary notwithstanding, remains unaltered.
The emotionalism of the approach, through its basic means of operating, carries an inherent weakness. The clue to the weakness involved came to the writer from an alcoholic’s autobiography in which he speaks of "sprees of salvation." 15. For some the mission experience is an emotional binge. Unless follow-up procedures are successful in maintaining the thrill, a spiritual hangover is apt to result. Out from under the influence of the leader and the surge of group emotion, the individual cools sufficiently to rue his actions and resent the manner in which he was swayed. Further, the primary emphasis on a sudden, dramatic experience leads to an under-emphasis on the less dramatic process of growth following the conversion.
Another barrier to permanent sobriety lies in what might be called the "diminishing returns of authoritarianism." Recall that a pivotal conflict in many alcoholics is between their need for and resentment of dependency. Straus found that most of the men he interviewed both valued the security of the Skid Row institution and felt hostile toward it. This is the inner struggle. As the initial euphoria of the conversion experience and acceptance by authority dims, the old conflict begins to exert pressure. The essence of mission therapy is dependence -- on God and on the mission. As the need to defy authority grows, the alcoholic reverts to his habitual defiance device-drinking. The authoritarianism of the mission approach was symbolized by one mission superintendent who paid his workers only fifty cents a week for their work because, as he put it, "that is all they can handle." Such benevolent authoritarianism is galling to the alcoholic who is hypersensitive to domination.
The fact that evangelistic aggressiveness is in some cases a product of disguised hostility is undoubtedly conveyed to the recent or prospective convert, to the detriment of permanent sobriety. Bowery resentment against mission evangelists is in part due to the feeling that they view men and are interested in them only as opportunities to save more souls. 16.
It would seem to be a safe assumption that a high percentage of converts are never assimilated into normal social living. Some of these remain "institutionalized," living at the mission and doing its work. They have capitulated to the dependent relationship. The fundamental tenet of benevolent authoritarianism -- "Do what I say and I’ll take care of you" -- tends to make weaning from immature dependency difficult. Others slip back into the maelstrom of Skid Row. If the individual succeeds in leaving the Bowery and making the difficult break from homelessness, the mission has no structure for continuing the group support which he will continue to need.
On the positive side it is well to remember that the mission approach does help some alcoholics to long-term sobriety and re-assimilation into society. The healing power of God is mediated through this approach to some degree. Even if a conversion involves the substitution of compulsive religion for compulsive drinking, there is a real gain for society. Further, the missions help ameliorate the grim lot of many Boweryites by their provision of physical essentials. The mission philosophy recognizes correctly that therapy for the low-bottom alcoholic must aim at returning him to society, must minister to his physical as well as his spiritual needs, and must involve some personality reorientation. Whether it achieves these goals in many cases or not, its goals are valid. The "halfway house" and fellowship groups for alcoholics are sound ideas that increase the likelihood that a given convert will make the grade.
It seems probable that the conversion experience may effect at least a partial reorganization of the personality in some cases. The director of research at Boston Hospital, Abraham Myerson, has written as follows: "Undoubtedly a Billy Sunday meets the deep needs of many alcoholics." 17. Back around 1930 L. Cody Marsh conducted an interesting experiment in group therapy with psychotics at Kings Park Mental Hospital on Long Island. His aim was to provide the "psychological equivalent of the revival on a secular level." He conducted "therapeutic classes" in which there was spirited group singing, rituals, inspirational lectures, and testimonials by patients who were making outstanding progress. After considerable experimentation, Marsh came to the conclusion that such group experiences had many positive results. Patients were motivated toward recovery, and there was a genuine release of emotion. There is undoubtedly an element of this kind of group therapy involved in the mission experience of some alcoholics. It is also well to remember that various missions differ somewhat in their approaches. Some are much more constructive than others.
An experiment at the Yale Plan Clinic for alcoholics has shown that home less alcoholics are almost inaccessible to the usual out-patient clinic procedures. Many have passed the age when psychiatric therapies have marked effectiveness in reorienting character structure. Even if they were likely prospects for more basic therapies, the resources are not generally available at present. In the light of these circumstances, it is appropriate to be thankful for the degree to which the missions are successful in ameliorating the tragedy of Skid Row.
The Salvation Army Approach to Alcoholism
The history of the Salvation Army is characterized by persistent concern with the practical application of religious ideals to the individual victims of social chaos. This practical orientation led the Army from its inception into the field of alcoholism. Firsthand experiences in the squalor of the London slums made the founder, William Booth, and his fellow Salvationists keenly sensitive to the problem. Booth agonized over the tragic plight of England’s half-million drunkards, and their "effective deliverance" was the keystone of his earliest program of social reform, as outlined in his magnum opus, In Darkest England and the Way Out. 18 Through the years this movement has tried various strategies for helping alcoholics. In the early days "Drunkards’ Rescue Brigades" were formed which went into the streets to help alcoholics.
For a while special "Inebriates’ Homes" were established. At least two "Inebriates’ Colonies" still exist, one on a Swedish island and the other on an island near New Zealand. A unique experiment in mass therapy for alcoholics was tried in New York just before the First World War. On a designated "Boozers’ Day" as many as twelve hundred alcoholics were rounded up in Skid Row areas and transported on double-decker buses to a great hall where they were exposed to a gospel meeting on a grand scale. In 1914 the converts of these meetings banded themselves into a fraternal organization devoted to the reclamation of other drunkards. It was known by the intriguing title of "United Order of Ex-Boozers."
On the corner of Bowery and East Third Street is an attractive three-story $400,000 building housing the Bowery Corps of the Salvation Army. This is one of fourteen Skid Row corps maintained by the Salvation Army. It is a vital link in the Army’s frontline attack on alcoholism. The importance which it attaches to this phase of its work is indicated by the excellent facilities provided.
The program, clientele, philosophy, and dynamics of the Bowery Corps are almost identical with those of the rescue mission. The program centers on the salvation meeting, which is almost indistinguishable from the gospel meeting described earlier. The program of physical aid and rehabilitation is quite similar. The dynamics of the conversion experience seem to be identical. One minor difference is that the regular salvation meeting is preceded by a "street meeting" in front of the headquarters. This is an abbreviated meeting designed to reach those who would not come to the indoor meeting and, if possible, attract them indoors.
A distinctive feature of the Bowery Corps program is Alcoholic Night, which is held once a week. This is a salvation meeting especially beamed at the problem drinker. Its existence shows a recognition of the fact that alcoholism is a problem which demands special attention. Originally, AA speakers were often included on Alcoholic Night. Under the present Corps leaders, AA speakers have been barred. One of the officers explained this restriction: "Some of the AA speakers would swear from our platform and say things not in line with our teaching. . . . Most of our institutions have AA groups. Here you’re either saved or you’re not."
It is significant that the Bowery Corps has recognized the need of new converts for a fellowship group. The Converts Club is such a group. Club members assist the officers in conducting meetings. One night a week there is a "fellowship meeting" open only to members of the Converts Club plus soldiers (regular members of the Salvation Army) and officers. This is the equivalent of the AA "closed meeting." Since most of the converts are alcoholics, the subject occupies the forefront of conversation at these meetings. Primarily because of the Converts Clubs, many converts continue to regard the Corps where they were "saved" as their spiritual home, even after they have become reestablished in society. At the Harbor Light Corps in Chicago, the Converts Club has grown to fifteen hundred members. During one year they contributed over $10,000 toward Corps expenses.
In addition to the Skid Row corps, the Salvation Army has its Men’s Social Service Centers which are spearheads in its approach to alcoholism. These are industrial homes which provide shelter, food, and employment for destitute men. During a recent year 21,265 men passed through the 111 such centers in this country. The Army is careful not to designate these as homes for inebriates, having discovered that they obtain better results with the more general label. The shops in the centers engage in repairing for resale huge quantities of used clothing and furniture. Major Peter Hofman, the head of one such center in Cleveland, reports, "We find our work program of immeasurable therapeutic value."
The centers conduct regular religious services which follow the familiar pattern. In addition, some of the centers have AA groups meeting on their premises. A man living at such a center may attend a gospel meeting one evening and an AA meeting the next. His rehabilitation may be due to a combination of influences, as in the case of Bob B.:
Bob B., 55, had been a machinist and stationary engineer. He had been drinking excessively for nearly twenty-five years and had spent eight years in various institutions taking cures. He came to Cleveland and placed himself under the care of the Salvation Army Social Service Center. The officers at the center tried various methods of approach, but still Bob B. could not stop drinking. They offered to introduce him to members of AA, but he refused flatly. Finally after a severe crisis and a terrific spree, he returned to the center completely licked. "For God’s sake get me an AA man," he said. Within an hour he was in an AA hospital. After four days he was returned to the center. When he was able, the officers contacted an industrial plant and arranged for him to start work. Bob has been sober now for over two years, is active in an AA group in the plant where he works, and attends a Cleveland church. He returns to the center at least once a month to do personal work with the men there. 19.
Unlike the rescue mission which is usually an isolated entity, the Skid Row corps and the Social Service Center of the "Sally" (as the organization is known on Skid Row) are a part of a network of installations and services, the therapeutic resources of which are all available for helping alcoholics. The Family Service Departments, for instance, are staffed by officers who are trained social workers. These agencies do a great deal to help the families of alcoholics, seeking to "add to the casework technique the spiritual values that have played a major part in the development of the Army." 20 The officer in charge of a standard Skid Row corps may refer a converted alcoholic to Family Services, which may provide psychiatric therapy or otherwise aid in the reconciliation of the family.
How Effective Is This Approach?
It is difficult to give an evaluation of an organization as large and as varied as the Salvation Army. In spite of its military, hierarchical structure, there are striking differences of approach from corps to corps, depending on the personality of the officer in charge. It would seem fair to say, however, that in general the Salvation Army represents evangelistic therapy at its best. There is good evidence that at least some of the corps have remarkable success in getting and keeping their clients sober.
Take the case of the late "Cap’n Tom" Crocker. As a young man Crocker was doing well as clerk in a Detroit court, that is, until his drinking got the best of him and he began to "borrow" funds entrusted to him by the court. Fired in disgrace, he was soon on Michigan Avenue, Detroit’s Skid Row. Here he spent eight horrible years until finally, in the desperation of alcoholic de lirium, he stumbled into a Salvation Army Rescue Corps and was soundly converted. He then joined the Army and went to work in that corps. Here his talent for helping alcoholics soon became apparent.
After a time the same judge who had fired him invited him to help as a court consultant for alcoholics. In 1948 Crocker was moved to the Army’s Harbor Light Corps on West Madison Street in Chicago. The judge of a municipal court, having heard of his work in Detroit, invited him to help. This is how the plan worked. Each morning at court the alcoholics who seemed to have the best chance of making a comeback were culled out and turned over to Captain Crocker. (In six months he took 3,048.) They were taken to the Corps, where he talked to them in the following vein:
Remember you don’t have to stay here. If you want to live like bums, I’m not going to stop you. Another thing, nobody has to do any phony praying to get help. I was on the street myself once, so I know a phony when I see one. But if you really want to lick Skid Row, I have the answer. We’ll help you get a job and teach you how to use a fighting faith in God. But you’ll have to supply the guts." 21.
The men who chose to do so were allowed to stay at the Harbor Light where they are exposed to conversion therapy and rehabilitation. The Chicago judge said of Crocker’s work: "Right from the start he did a wonderful job." Of the 3,048 alcoholics mentioned above, 789 experienced conversion. Considering the type of low-bottom alcoholic involved, this proportion is strikingly high. Even more significant is the fact that 331 of the 789 converts returned to their homes.
Crocker was probably a uniquely successful worker with alcoholics, but there is evidence that other centers also enjoy considerable success. For instance the officer in charge of a rehabilitation center for homeless men in New York State writes, "We consider about 25 percent rehabilitated." What factors are responsible for the greater effectiveness of the Salvation Army, as compared to the rescue mission approach?
One factor of special importance is the greater degree of insight on the part of some Army leaders into the alcoholic’s needs and behavior. Conceptions of alcoholism within the Army range from the moralism of the mission type to an attitude of enlightenment which regards alcoholism as a sickness. This enlightened wing is well represented among the higher officers of the organization and this, of course, is the basis of a realistic hope for more widespread effectiveness in the future. An interesting aside is the fact that William Booth himself regarded alcoholism as a disease, at least in some cases. He wrote:
"After a time the longing for drink becomes a mania. Life seems insupportable without alcohol as without food. It is a disease often inherited, always devel oped by indulgence, but as clearly a disease as ophthalmia or stone." 22.
Booth was aware that there is a physical component in the disease and wrote of "treating the passion as a disease, as we should any other physical affection, bringing to bear upon it every agency, hygienic and otherwise, calculated to effect a cure." 23. Alcoholism has always been regarded by the Army as involving sin, but not in the naïve sense of being simply the personal failure of the individual alcoholic. Booth, in fact, spoke of gin as "the only Lethe of the miserable" and regarded the saloon as "a natural outgrowth of our social conditions." Society, he pointed out, "greased the slope down which these poor creatures slide to perdition." Society should therefore take responsibility for helping them.
Although some in the present-day Army do not share Booth’s remarkable early insights, there seems to be a strong "back to Booth" movement in this regard. One hopeful indication of this is the fact that a number of key officers have attended the Yale (and Rutgers) School of Alcohol Studies. Another is the existence of a National Commission on Alcoholism. The commission, charged with the task of reviewing and improving the Army’s approach to alcoholism, has come forward with a number of very progressive recommendations. For example:
The Commission recommends that the program of each Men’s Social Service Center should be so arranged as to adequately meet the need of the alcoholic, and that it should include counseling services, medical and psychiatric services and a comprehensive recreational program under a trained recreational director. 24.
Because of his enlightenment regarding alcoholism, the Salvationist is often better able to convey genuine personal concern to the alcoholic. William James commented on this concern in his Varieties: "General Booth . . . considers that the first vital step in saving outcasts consists in making them feel that some decent human being cares enough for them to take an interest in the question whether they are to rise or sink." 25.
Another factor in the success of this approach is its well-developed system for consolidating the conversion experience. One aspect of this is the military structure of its organization. In World War II some men who had trouble with alcohol before and after had little trouble during their period of service because they found a security in the authoritarian army structure. The Salvation Army structure seems to serve the same function for some converts. They become a part of a worldwide military organization engaged in an all-out "war" against sin. They are made to feel uniquely useful (for saving others) and given a great mission. As soldiers or officers they must be absolutely obedient to their superiors. The organization provides for all their physical needs. There is a security in such a system that appeals to a dependent person. Fur ther, wherever a Salvationist goes, he is a part of an in-group which requires absolute abstinence from alcohol from all its members.
Unlike the haphazard follow-up procedure of the mission, the Salvation Army has put its modus operandi into a systematic series of steps, similar to the "Twelve Steps" of AA:
1. The alcoholic must realize that he is unable to control his addiction and that his life is completely disorganized.
2. He must acknowledge that only God, his Creator, can re-create him as a decent man.
3. He must let God through Jesus Christ rule his life and resolve to live according to His will.
4. He must realize that alcohol addiction is only a symptom of basic defects in his thinking and living, and that the proper use of every talent he possesses is impaired by his enslavement.
5. He should make public confession to God and man of past wrongdoing and be willing to ask God for guidance in the future.
6. He should make restitution to all whom he has wilfully and knowingly wronged.
7. He should realize that he is human and subject to error, and that no advance is made by covering up a mistake; he should admit failure and profit by experience.
8. Since, through prayer and forgiveness, he has found God, he must continue prayerful contact with God and seek constantly to know His will.
9. Because The Salvation Army believes that the personal touch and example are the most vital forces in applying the principles of Christianity, he should be
made to work continuously not only for his own salvation but to help effect the salvation of others like himself. 26.
Although there is a real question as to how widespread the use of these steps is in actual practice, their existence indicates the greater concern of the Army with an orderly therapeutic process.
Another factor in the greater success of this approach is the eclectic spirit (as distinguished from the exclusivistic spirit of the mission) in which the resources of social work, psychiatry, medicine, and AA have been integrated with their basic evangelism. A remarkable exception to this was the case of Captain Tom Crocker who rejected the offer of a full clinical setup, complete with social workers and psychiatrist, in favor of the straight-evangelistic approach. His success probably indicates the crucial importance of the personality of the individual therapist, whatever his method. The bulk of Army leadership seems to believe that an effective approach to alcoholism must be a "team job." In keeping with its broader spirit, this leadership in general recognizes abstinence as a worthy goal of therapy. This is in contrast with mission thought which considered only complete salvation as a goal. One mission leader said, in fact, that it might be better for a man to stay drunk if he is going to hell anyway.
There are several weaknesses in Salvation Army thought and therapy which prevent it from being more effective with alcoholics. Some alcoholics, judging by the author’s interviewees, deeply resent the authoritarian structure of the Army and the theologically disguised power-drives of certain officers. One of the author’s interviewees, a convert of the Salvation Army, was sharply critical, comparing it to Roman Catholic authoritarianism. There is still a considerable amount of moralism concerning alcoholism among the rank and file Salva tionists. There will probably always be a degree of "sin-sickness" in the Salvation Army conception of alcoholism. Although the benevolent authoritarian solution (in terms of organization and philosophy) may be the best available to many low-bottom alcoholics at the present, it is doubtful whether it contributes to the eventual spiritual growth and freedom of mankind. At the time when William Booth came forth with In Darkest England and his dictum that "society needs mothering," T. H. Huxley wrote a series of protest letters to the London Times, in which he pointed to the dangers of "blind and unhesitating obedience to unlimited authority" and showed that "mothering" adults does not contribute to their maturity and growth. One need only recall Erich Fromm’s Escape from Freedom to be reminded that an authoritarian religious or political system may be attractive to neurotic people and yet not be psychologically constructive. This does not apply, of course, to the Salvation Army in general, but apparently there are some segments of its leadership which unwittingly use the Army system to encourage dependence, not independence, conformity to the system, not individual self-realization. We can agree with Huxley to the extent of recognizing that "mothering" adults is hardly the road to emotional and spiritual maturity.
In spite of these criticisms of the Salvation Army approach to alcoholism, it is still true that, compared with the rescue mission approach, the Army’s is progressive and relatively more effective. In an area like Skid Row where so little is being done, it is not wise to be perfectionistic in one’s judgments. Whatever the inadequacies of its approach, the "Sally" has been helping alcoholics for a long time. For nearly five decades it devoted itself to alcoholics when almost everyone else considered them hopeless. Concerning their work, Selden Bacon, of Rutgers, has said: "It has been criticized justifiably but no body else is doing the job on Skid Row or has been doing it for the past fifty years." It is noteworthy that when the Yale Plan Clinic for alcoholics was first organized, it found it necessary to provide beds for some of its patients. After a vain search through the usual social agencies, the clinic leaders found one group that would help -- the Salvation Army.
At its best, the Salvation Army approach can show highly significant results. Two Men’s Social Service Centers in California received federal grants which permitted augmentation of their professional staffs and expansion of their rehabilitation programs. A follow-up study of 293 homeless alcoholics treated at the centers was done six months after they had left the centers. The approximately one hundred of these who were located showed the following improvement in their drinking patterns: 23 percent -- great improvement; 25 percent -- moderate improvement; and 53 percent -- no improvement. In the area of vocational functioning, improvement was smaller: 18 percent -- great improvement; 22 percent -- moderate improvement; and 61 percent -- no improvement. It must be pointed out that the educational level and past occupational attainment of this group were higher than typical samples of homeless alcoholics, improving their chances of recovery. However, the fact that nearly half of an above-average homeless group showed improvement in their drinking patterns and 40 percent showed improvement in their employment records is impressive indeed. Participation in some form of vocational counseling while in the programs was the factor most strongly correlated with later success. 27.
One must respect the Army for its devotion to low-bottom alcoholics, its willingness, in the words of its founder, to "net the sewers" for Christ. Without a doubt, a great host of reformed alcoholics must give thanks that in the Salvation Army’s book there are no incurables. "A man may be down but he’s never out" because "the word ‘hopeless’ isn’t in God’s dictionary!" This is the Army’s dauntless faith.
What We Can Learn from These Approaches
By way of summary, a listing of the practical implications which may be derived from these approaches will now be made. The degrees to which both do succeed indicate:
1. Low-bottom, homeless alcoholics can be helped by religious means.
2. Evangelistically oriented approaches which can induce a powerful emotional experience are able to help some alcoholics who perhaps could not be helped by more rational approaches. If a religious approach to alcoholism is to be effective, it must convey to the alcoholic the fundamental feeling of acceptance. For his sense of rejection by life, it must substitute an inner conviction that he has been accepted by life. (This is the experience of "salvation by grace through faith" which is so central in vital Protestantism.) Apparently the evangelistic approaches are able to be channels for his experience in some cases. Because of its general enlightenment, the Salvation Army is more successful than the rescue mission in this regard.
3. The "whole-man" type of therapy is essential with low-bottom alcoholics. This suggests referral of low-bottom alcoholics to those institutions especially equipped to help them physically as well as spiritually, and to provide residential facilities during treatment.
4. The importance of continuing support of converts by some type of fellowship group (such as Alcoholics Victorious or the Converts Club).
5. The necessity of substitute religious and group satisfactions to replace the satisfactions of alcohol.
6. The importance to their continued sobriety of putting converts to work helping others with like affliction.
7. Alcoholics have an advantage in helping other alcoholics. This is implicit in the fact that many of the most effective mission and Salvation workers are themselves ex-alcoholics. The Salvation Army explicitly recommends that, so far as possible, ex-alcoholics be used in such work, but it is also recognized that many nonalcoholic officers do commendable work with alcoholics.
8. Homelessness as well as alcoholism must be treated.
The relatively greater effectiveness of the Salvation Army approach suggests:
1. That referral of homeless alcoholics to a Salvation Army Corps is usually preferable to a rescue mission. There are great variations in the enlightenment and effectiveness of different missions and different Army corps. Some missions are more desirable than some Army installations, depending mainly on the leadership. However, one is more likely to find a more enlightened and effective approach in the Salvation Army than in the typical rescue mission.
2. That an adequate conception and understanding of alcoholism is a necessity in fashioning an effective therapy.
3. That the flexible, eclectic approach which utilizes the resources of all available agencies and therapies has a much better chance of succeeding than the exclusivistic evangelistic approach.
The failures and weaknesses of both approaches suggest:
1. The low-bottom alcoholics are an exceedingly difficult group to help because of their general disintegration and their exile from normal living.
2. The importance and difficulty of handling the dependency problem in a constructive fashion with alcoholics. Both these approaches resort to an authoritarian structure and philosophy as a means of helping alcoholics. Granting that this may be the best available solution for some alcoholics, one must still face the problem of the alcoholic’s rebelliousness toward authority. The converts who become permanently attached to the authority-dependency system are the other side of the same problem.
3. The percentage of failures by both groups suggests the need for trying other than evangelistic approaches with homeless alcoholics. For the record it should be noted that there are other approaches which are being tried, including an experiment in the use of temporary institutionalization, Antabuse, and group psychotherapy with such alcoholics. (See Chapter 10 for a description of these approaches.) Further, AA has helped many low-bottom alcoholics. There are AA meetings in some municipal lodging houses, rehabilitation centers, and halfway houses focusing on "low-bottom" alcoholics. In several communities there are "Twelve Step Houses," and halfway houses have been organized and directed by the members of a certain AA group or groups. Although these are not affiliated with AA (the AA traditions do not permit official affiliation with any institution), their treatment is AA-oriented, and there is a close working relationship. In a sense, when such facilities reach members of the homeless alcoholic population, they constitute a kind of AA equivalent to the rescue mission. Recently, the use of the name "Twelve Step House" has been discouraged by AA, since it gives the erroneous impression that they are AA facilities.
1. Jerry Gray (pseud.), The Third Strike (New York and Nashville: Abingdon Press, 1949),p. 11.
2. Nels Anderson, The Hobo (Chicago: University of Chicago Press, 1923); E. H. Sutherland and H. J. Locke, Twenty Thousand Homeless Men (Philadelphia: J. B. Lippincott Company, 1936).
3. "Alcohol and the Homeless Man," QJSA, VII (December, 1946).
4. Ibid., p. 385.
5. D. J. Pittman and C. W. Gordon, Revolving Door, A Study of the Chronic Police Case Inebriate (New Haven: Yale Center of Alcohol Studies, Publication Division, 1958).
6. Ibid., p. 145
7. Joan Jackson and Ralph Connor, "The Skid Road Alcoholic," QJSA, XIV (September, 1953), 468-86.
8. From an address by Thomas B. Richards, Executive Director, Men’s Service Center and Halfway House, Rochester, N.Y., entitled "A.A. Oriented Halfway House and the Service Center," at the June, 1966, conference of the Association of Halfway House Alcoholism Programs of North America.
9. Revolving Door, A Study of the Chronic Police Case Inebriate, pp. 143-44.
10. C. M. Diserens and Harry Fine, A Psychology of Music, The Influence of Music on Behavior (Privately published, 1939).
11. "He Needs Your Helping Hand," A Bowery Mission brochure, 1949.
12. Jerry McAuley, History of a River Thief (New York: privately published, 1875).
13. "Alcohol and the Homeless Man," p. 399.
14. "What Does It Cost to Save a Man?" A Bowery Mission brochure, 1951.
15. Harold Maine (pseud.), If a Man Be Mad, p. 181.
16. This was the strong impression I got from talking to men on the Bowery and from the interviewees who had lived on the Bowery.
17. "The Treatment of Alcohol Addiction in Relation to the Prevention of Inebriety," QJSA, V (September, 1944), 197.
18. (London: International Headquarters of the Salvation Army, 1890.)
19. From a report presented by Major Peter Hofman at a symposium conducted by the Research Council on Problems of Alcohol (undated).
20. Service, An Exposition of the Salvation Army in the U.S., p. 49.
21. Paul Robb, "Cap’n Tom -- The Other Side of Skid Row," Guideposts, April, 1951.
22. In Darkest England, p. 48.
23. Ibid., p. 186.
24. From the minutes of the Commission, May 16, 1946.
25. The Varieties of Religious Experience, p. 200, n. 1.
26. Presented at the Yale Summer School, 1943, by Envoy J. Stanley Sheppard and quoted in "The Salvation Army and the Alcoholic."
27. Lawrence Katz, "The Salvation Army Men’s Social Service Center: I. Program," QJSA, XXV (1964), 324-32; "II. Results," QJSA, XXVII (1966), 636-47.
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