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 8 - Laying the Groundwork for Counseling Alcoholics
How to understand the alcoholic and what can be done for him rank first and second in the list of problems which prove most puzzling [to religious leaders]. While religious influence in the deepest sense seems almost indispensable to the real cure of an addict, few seem to find this through conventional religious channels. Not all the reasons for this are clear; but the fact deserves further attention and study. Unless more light is thrown on this question, "therapeutic religion," or the religion which heals, may be developed quite outside the church. 1.
This paragraph was written in 1942 by Seward Hiltner, at that time head of the department of pastoral services of the Federal Council of Churches of Christ in America. Although well over two decades have passed since it was written, it describes the need and challenge of the present situation, to a considerable degree.
The Ministerís Attitude Toward His Opportunity
In this day in which teams of scientists are devoting their skill to the problem of helping alcoholics and AA has achieved such impressive success in leading thousands to sobriety, the pastor examines his own meager success in the field and wonders whether he should leave such work to the scientists and to AA. Is there a real need any longer for him to be active and informed concerning alcoholism? Can he expect to be reasonably effective if he is? We will attempt to throw some light on these questions in the six chapters that lie ahead. For one of the greatest needs of the minister is a definition of his role in the problem of alcoholism -- a clear picture of where he is needed and in what areas he can function most effectively.
One important element in this definition of his role is the recognition that dealing with alcoholics in a constructive manner is a major opportunity as well as a major problem for the parish minister. Ministers who have had experience in a parish do not need to be told that they will have opportunities to help alcoholics. Such opportunities -- a rather euphemistic term for some of the encounters a minister has with alcoholics -- are thrust upon him, whether or not he wants them or is prepared for them. The question is not whether he will deal with alcoholics; the question is whether he will deal with them in a more or less constructive manner. But for the young man just beginning his ministry and for the older minister who has just not had many opportunities in this area, it is important to cite evidence that many ministers are active and relatively successful in helping alcoholics.
A survey conducted by Yale University in cooperation with the National Council of Churches revealed that fifty to fifty-five thousand alcoholics a year are seen by ministers in the United States. 2. More significant than the mere number is the fact that the minister, so the survey showed, is often the first person seen for help, outside the family of the alcoholic. Other studies confirm the fact that the average minister sees several alcoholics in the course of a given year. For example, a study made by the New York Academy of Medicine and reported in "A Survey of Facilities for the Care and Treatment of Alcoholism in New York City" 3. showed a high number of referrals to clergymen. Another example is from a report of the New Hampshire Board for the Treatment of Inebriates which mailed a questionnaire to various professional persons within the state. 4. The 91 clergymen who returned questionnaires reported having counseled with a total of 353 alcoholics during that year. Interestingly enough, this was nearly double the number of cases reported by a group of 119 New Hampshire clergymen two years before. During the same two-year period, AA grew from 3 groups to 14 in the state. This suggests, although the samples are too small to be conclusive, that an increase in the work of AA actually increases pastoral opportunities with alcoholics. If this is true, it is a most convincing answer to those who feared, as well as those who hoped, that AA would render the churchís ministry to alcoholics unnecessary.
With the financial help of Columbia Universityís interdepartmental seminar on religion and health, this writer conducted a survey of the 324 clergymen who had attended the Yale Summer School of Alcohol Studies during the first seven years of its existence (1943-1949). Questionnaires designed to ascertain their thinking and action concerning alcoholism were mailed to them;
-146 were completed and returned. Eighteen denominations, including all the major Protestant groups, were represented. Geographically, the respondents represented 37 states and Canada. The work and thought of these 146 ministers are being cited as vivid and concrete examples of what a group of clergymen who are trained in the field are thinking and doing. On the point under consideration, it is significant that the 75 ministers who gave definite information in this area had seen an average of 4.9 alcoholics per year since attending the Summer School. This average includes sixteen men who had counseled with no alcoholics during this period. Thus, the evidence from the various sources mentioned indicates that the pastor should expect to have a number of opportunities each year to help alcoholics. He has a job to do, and he must be prepared to do it well!
Can a minister hope to be effective in dealing with alcoholics? The feeling expressed by some AA members that "only an alcoholic can help an alcoholic" has influenced the thinking of many ministers to the detriment of their confidence in their own ability to really help the alcoholics who come to them. Again, the experience of the 146 Yale ministers can be helpful. How effective were they in dealing with the alcoholics who came to them? The picture is encouraging. In general, those who had had considerable opportunity to work with alcoholics showed a great deal of understanding and realism concerning the psychology and methods of such work. It is probably true that those who had considerable insight and success in working with alcoholics tended to develop a reputation for success in this area and therefore attracted more alcoholics to them. Several of the ministers either mentioned or implied that they had acquired such a reputation and that physicians, court officials, or other clergymen had referred alcoholics to them f~or help. In other words, the very fact that such a large proportion of the Yale ministers had worked with a substantial number of alcoholics is ipso facto evidence that they were doing an effective job with them.
The ministers were asked to give an evaluation of their success in dealing with alcoholics. Feeling toward the value of their work ranged from that of one minister who reported: "I have never found a drunk who wasnít worth my time and attention and it meant a lot to them," to the man who wrote, "As far as my experience goes, it is a discouraging piece of work trying to help people who do not want it." The general feeling was between these extremes, the majority closer to the first -- viz., work with alcoholics involves many discouragements, but it is exceedingly important and worthwhile. As one minister put it, "Some cases have responded beautifully. In others, I have been able to do exactly nothing." Two thirds of the ministers reported 50 percent or better success in dealing with alcoholics. Most of the ministers reported working closely with AA, and the majority of them had a positive attitude toward the use of psychiatric referral with alcoholics when needed. The overall impression derived from the questionnaires was one that shows the fallacy of the conception that only an alcoholic can help an alcoholic. The impression was this -- here is a group of individuals making a significant and continuing contribution to the work of helping individual alcoholics to sobriety. It is likely that many of these men would have been making a significant, though perhaps not as great, contribution even if they had not attended the Yale Summer School. Their effectiveness is but a sample of the work with alcoholics that thousands of ministers over the country are actually doing. There is no valid basis for the feeling of any minister that he cannot make a significant contribution to helping alcoholics because he is a minister or isnít an alcoholic!
However, realism demands that a minister face both his advantages and limitations in dealing with alcoholics. The 146 Yale ministers were asked to list what they felt were a ministerís chief advantages and limitations. The general feeling was that the minister has more advantages than limitations. The limitations most often mentioned could be divided into two categories: the alcoholicís attitude toward the minister and the ministerís attitude toward the alcoholic. In the first category were the alcoholicís fear that the minister will censure him, the alcoholicís suspicion of the minister as a professional "do-gooder," the alcoholicís resentment of religion, and the difficulty of establishing rapport because the alcoholic may feel that the minister (not being an alcoholic) never quite understands him. One respondent wrote, "Most folks figure the minister has a set attitude toward alcoholics and will therefore not give him much opportunity except in Ďhopelessí cases." In the second category of limitations were mentioned such matters as the ministerís tendency to moralize and to "preach at" rather than to "counsel with." Included in the advantages mentioned were the natural entree to the family, confidentiality of relationship, the fact that there are no fees involved, that many people naturally take their problems to their pastor, and, most important, that the minister has the dynamic of the Christian faith and fellowship available for helping the alcoholic. One respondent summarized the feeling which several expressed:
"The only important limitation a minister has is the initial hesitancy of the alcoholic to approach a minister. Beyond that, it is an advantage to be a minister, provided you have the right attitude and understanding."
Discovering Opportunities to Help
One of the striking discoveries from the Yale ministersí responses was a wide range in the number of helping opportunities which the individual ministers had. Sixteen had had no opportunities. On the other hand, twenty-one men had been very active, sixteen of these having seen an average of ten or more per year. Obviously, for the minister who is interested in rendering maximum service in this area, it is important to ascertain the factors which influence the number of opportunities a man has.
The type of parish one serves is an important factor in this matter. For instance, a pastor in a downtown church is more likely to have a considerable number of transient alcoholics come to him than is a minister of a suburban church. Another factor is the ministerís relationship with AA. A large proportion of those respondents having much higher than average yearly figures were those having AA groups meeting in their church halls, or otherwise having a close relationship with AA. Another factor is the denomination to which one belongs. Although the picture is not clear from the questionnaires, it seems probable that some alcoholics tend to shy away from ministers who belong to denominations associated in the public mind with the militant temperance movement. Apparently some alcoholics do so without bothering to discover whether or not the individual minister actually represents his denominationís position. However, in this regard, there is little doubt that the personality and approach to people of the individual minister are much more important factors than is his denomination.
A ministerís general attitude toward alcohol, alcoholics, and alcoholism seems to have a direct relationship to the number of alcoholics who come to him for help. The Yale ministers were asked what position they advocated regarding prohibition and the use of alcohol. Those who advocated total abstinence and the return of prohibition had seen an average of 3.6 alcoholics per year. Those who advocated total abstinence but did not favor prohibition had seen an average of 3.9 alcoholics per year. Those who advocated moderation and opposed prohibition, in contrast to the first two groups, had seen an average of 6.5 alcoholics per year. Those who advocated no position but left the decision to the individual had seen an average of 11.9 alcoholics per year. Significantly, all but one of the sixteen ministers who had had no counseling opportunities were included in the first two positions.
The Yale ministers were asked to indicate whether they considered alcoholism a sin or a sickness (or both) and what they considered the chief causes. For purposes of comparison, two extreme groups within the total group of respondents were studied. It was found that those who considered alcoholism primarily or entirely a matter of sickness had seen a yearly average of 9.3 alcoholics, whereas those ministers who considered alcoholism primarily or entirely a matter of sin had seen a yearly average of only 2.3 alcoholics. In other words, those ministers who accept the sickness conception of alcoholism had had over three times the average yearly opportunities available to those who did not accept it.
On the question of the causes of alcoholism, the Yale ministers were again divided into categories. At the two extremes were (a) those who considered alcohol and drinking to be the primary causes of alcoholism and (b) those who considered the socio-psychological and physical factors to be the primary causes. Those in the first group, that is, those who fail to take cognizance of the modern scientific findings concerning alcoholism, had seen an average of only 1.9 alcoholics per year, while the other group had seen an average of 6.8 per year.
From these figures it is apparent that a ministerís general attitudes toward alcohol and alcoholism have a great deal to do with whether or not he discovers the alcoholics who are potentially available to be helped by him. If a minister is known as a militant advocate of prohibition and temperance, and if he treats alcoholism in a moralistic fashion in his public pronouncements, it is likely that some alcoholics who might otherwise seek his help will give him a wide margin. The alcoholic does not come to him because he fears, with good reason in some cases, that he will meet censure rather than understanding. The decisive factor in this matter does not seem to be the ministerís personal convictions regarding the use of alcohol, but the way in which he chooses to present his convictions. Alcoholics are often hypersensitive to those they consider "bluenose" or "reformers" -- i.e., those who condemn all drinking. Therefore, a minister who holds to the temperance view would seem to be in a position of having to choose whether he will make this a major emphasis or whether he wishes to counsel alcoholics. It may be that there is no actual decision involved in most cases since the man who has the inclination to do the one would probably not be adept at the other. However, the personality of the minister, as we have said, is of primary importance in this whole question. This explains why there are some pastors who are outspoken temperance advocates and yet carry on effective counseling ministries with alcoholics.
Let us look more closely at this personality factor, in the light of the problem of discovering opportunities to help alcoholics. It is probable that a majority of all alcoholics are of the "hidden" variety -- individuals who are having serious problems with alcohol but whose behavior is still enough within the bounds of social conformity to allow their alcoholism to be kept secret within the family. The interpersonal suffering and chaos caused by their social malignancy is assiduously kept from the outside world. The pastor wants to discover these situations within his parish, not only because the alcoholic and his family need help which he may be able to give, but because help rendered at this stage of the illness may save them from years of suffering.
The hiddenness of so much alcoholism constitutes the most baffling aspect of the problem from the standpoint of treatment. It is ironic that in spite of the new helping resources that are now available, the majority of alcoholics and their families continue to suffer the ravages of the illness. The major reason for this is simply that a hidden illness cannot be treated. One student of the problem estimates that not over one million of the five million plus alcoholics in his country are now or have been in treatment of any kind. It is essential that more effective ways be found of bringing the hidden alcoholics out of hiding to be helped. The minister has a significant role to perform in helping to solve this problem.
How does one encourage people in this sort of trouble to come to him and entrust their painful problems to his confidence? We have seen how the ministerís attitudes toward alcohol and alcoholism influence his opportunities to help. Equally important, and somewhat related, is what the late Otis R. Rice, pioneer in pastoral work with alcoholics, called "remote preparation for counseling of alcoholics." 5. By this he meant the pastorís general relationship with his people in his varied contacts with them. This is determined by the pastorís personality structure. Has he made his people feel that he is really interested in them as persons and not just as means of running a church machine? Has he established a relationship with his people that has made them feel that they can be sure he will keep their confidence and that he will not be made uneasy by their recital of the grim facts of their situation? Is he relatively shockproof? Can he be counted on to really listen to them rather than to talk because what they are saying makes him anxious? Will he be with them in feeling, or will he be sitting in judgment as they pour out their hearts? Are his general attitudes moralistic, or do his sermons and talks reveal a deeper understanding of human behavior? If a pastorís remote preparation is good, then people with painful problems, including alcoholics, will come to him seeking help.
The clergyman is in a strategic position to attract the hidden alcoholic out of his dark closet of fear and despair. There are at least three specific means of accomplishing this:
1. Educational seed planting. A productive way of creating greater openness to help is to deal with alcoholism in a sermon or talk, and to do so in an understanding and accepting manner. If the minister reveals a non-moralistic, enlightened grasp of the problem, the alcoholic or, more often, his spouse, may feel motivated to seek the pastorís help. An appreciative mention of AA and other treatment methods may awaken the personís hope that perhaps something can be done about his problem. Mentioning alcoholism or AA in a sermon almost invariably results in at least one counseling opportunity. In most congregations there is at least one individual who has a personal but hidden interest in the problem. If that person senses that the minister has both insight and a nonjudgmental attitude toward his problem, it is likely that he will muster his courage and ask for a personal conference. In some cases, being introduced to the illness conception and early symptoms of alcoholism will help to open the personís eyes to the nature of his problem and his need for help. This is especially true of the spouse or other relative of the alcoholic who has not recognized the illness.
By his own public statements and also through his role of helping to develop an alcoholism education emphasis for the youth and adults in his church school, the minister helps to plant the seeds of understanding of the nature and treatment of alcoholism. (The contents and methodology of alcoholism education will be discussed in Chapters 12 and 13.) Some of these seeds will have a preventive effect. Others will flower subsequently in counseling and pastoral care opportunities.
2. Pre-counseling and pastoral care. In his normal pastoral functions, the clergyman has regular contact with a network of families. Furthermore, unlike most other professionals, he is expected to call in the homes of his people-without a special invitation. These two facets of his professional role definition give the minister a potential advantage over those in the other helping professions, so far as the early recognition of distressed persons is concerned. If his emotional radar is tuned to the wavelength of persons, the minister often will sense that a particular family is troubled (perhaps by hidden alcoholism), long before the crisis becomes full-blown and the family is forced by its pain to seek outside help. If a pastor suspects that a particular person or family may be showing the surface stress of a hidden problem, he should make himself easily available to them psychologically, by frequent pastoral care contacts. The process of building relationship bridges over which burdened people can bring their hidden problems to the minister for help is a part of the process which Seward Hiltner calls "pre-counseling." Clergymen in those traditions in which hearing confessions is a regular function have an opportunity to identify hidden alcoholics. Whether or not the opportunity is used depends on the ministerís sensitivity to the problems which lurk behind surface disturbances and his ability to help his parishioner move from the confessional to the counseling relationship.
Some of the distress signals which may indicate the presence of hidden alcoholism and/or other problems are these: disturbed children, veiled antagonism between spouses, chronic financial problems, repeated job losses for no apparent or convincing reason, drinking at inappropriate times, guilty avoidance of the clergyman or embarrassment when he calls, a radical change in behavior such as an unexplained withdrawal from church participation. Some of these symptoms may be coded cries for help by individuals or families who cannot bring themselves to ask for help openly.
Here is an illustration of the bridge-building function of pastoral care in creating counseling opportunities in cases of suspected alcoholism:
A pastor had reason to suspect, because he had observed several of the above signs of disturbance, that one of his parishioners, Mr. L., was having serious trouble with alcohol. Yet neither Mr. L. nor his family had contacted him concerning the problem. So, he made it his business to devote more than average attention to L. and his family. He called in their home for various reasons which were actually incidental to his main purpose. After a number of pastoral contacts of this type, he received a phone call from Mrs. L. saying that she would like to talk with him about a problem connected with the womenís group in the church. When she came to the pastorís study, Mrs. L. began by discussing this problem. Later in the interview she opened up concerning her husbandís drinking. Through their discussion, the pastor discovered that L. himself was apparently not ready to admit that alcohol was giving him trouble, and that he was not willing to talk with the pastor about his problems. So, the minister concentrated on helping Mrs. L. who was open to counseling help. He encouraged her to pour out her painful, pent-up feelings, and thus gain some relief from their pressure. He discussed with her the nature of L.ís problem and the crucial importance of helping him move toward at least minimal openness to outside treatment. Furthermore, he offered Mrs. L. an ongoing supportive counseling relationship to assist her in coping constructively with her feelings and problems in her relationship with her husband and children.
This pastor utilized well his professional entrée to the L.sí home. When he called on them, he did not initiate a discussion of L.ís drinking. To have done so probably would have defeated his purpose by putting L. and perhaps L.ís wife on the defensive. Instead, he concentrated on strengthening a relationship of trust with the L.s. This eventually made it possible for Mrs. L. to confide in him.
Under what circumstances should the minister take the initiative in raising the issue of excessive drinking with a parishioner? This will vary, depending on the clergymanís style of relating and the circumstances in a particular case. In general, there are two guidelines which should be followed. First, take the initiative when it is reasonably clear that the person has a drinking problem, when the pastor-parishioner relationship bridge is strong enough to survive the threat of such a confrontation and when the person does not open up on his own, in spite of frequent opportunities. Second, it may be essential to take the initiative, even if the relationship is not robust, when irreversible emotional or physical harm is being done to the children. If the person is an alcoholic, he will usually experience even the best-intentioned pastoral concern about his drinking as an accusation and a threat. Thus, taking the initiative is a calculated risk which may do more harm than good in the sense of solidifying the alcoholicís resistance to accepting help. For this reason, one usually is not justified in taking the risk, except in emergencies or in cases in which the pastor has a sturdy relationship with the person. In some cases, the alcoholic may give subtle clues that he is on the verge of discussing his problem and would like to do so, but is having trouble "breaking the ice." A gentle observation or question by the pastor may help. Here are some examples of possible "openers":
I get the feeling that thereís something thatís worrying you, but itís not easy to talk about.
You seem to have a burden on your mind. Can you tell me about it?
Do I sense that you are wondering if your drinking might be moving toward becoming a problem?
You seem to be carrying a load of some kind. Can I help?
The important thing is to offer help and to raise if necessary the possibility of a drinking problem in such a way as to allow the person to reject the statement without rejecting the minister. If the person is highly defensive, this is easier said than done, and the minister will sometimes miscalculate the degree of initiative he can take and achieve constructive results.
3. Counseling. Many people spontaneously turn to a clergyman when they are going through "deep water" of any kind. Among those seeking pastoral help are some whose disturbance in living is associated with or caused by alcoholism which may be hidden from themselves, in that they do not recognize the compulsive quality of their drinking. Some who are dimly aware that their use of alcohol is out of control are afraid or ashamed to admit this fact to others. By being sensitive to the possible presence of hidden alcoholism behind marital and other problems, the pastor can help the person or the family identify the hidden problem and seek appropriate help. Another group of alcoholics encountered in pastoral counseling are those whose abnormal drinking is painfully obvious to the "significant others" in their lives, but not to themselves. Such persons often resist help tenaciously. The various methods which have proved useful in motivating the resistant alcoholic will be discussed in the next chapter.
Goals in Counseling Alcoholics
What are the goals of counseling with alcoholics? A clear, realistic answer to this question is essential to effectiveness. Much of the lack of precision in counseling procedures is a result of the counselorís confusion about goals or his striving for unrealistic ones.
The master goal of all pastoral counseling, including that which involves alcoholism, is to help the person grow toward his full potential for personhood, constructive relationships, and productive living. When counseling with an alcoholic, another goal is implicit in this master goal -- helping the person to achieve ongoing abstinence from the use of beverage alcohol. Stable abstinence is, for most alcoholics, a prerequisite for progress toward a happier, more constructive life.[ In counseling with some chronic alcoholics, more limited goals prove to be the only ones that are realistic or achievable. For example, a reduction in the number of binges, hospitalizations, days lost from work, arrests for drunkenness per year represent significant improvement, even though the ideal goal of permanent abstinence is not achieved. In an illness like alcoholism, any degree of improvement is valuable, however short the ideal goal. See Alcohol Problems, A Report to the Nation by Thomas F. A. Plaut, p. 35.]
The inability of the addicted drinker ever to drink again in controlled fashion was accepted as axiomatic for many years by most lay and professional persons engaged in helping alcoholics. The axiom was summarized by a phrase often heard in AA -- "Once an alcoholic, always an alcoholic!" -- and by the statement frequently repeated by those doing therapy with alcoholics -- "Alcoholism can be arrested and treated, but not cured." This basic therapeutic assumption has been challenged in recent years. Because so much is at stake in terms of counseling goals, it is necessary to review the new evidence.
The challenge was initiated by the publication in 1962 of a report by a British physician, D. L. Davies, entitled "Normal Drinking in Recovered Alcohol Addicts." 6. He told of seven men, out of a group of ninety-three treated for alcohol addiction, who subsequently had been able to drink normally for periods of seven to eleven years. The treatment consisted of Antabuse and individual discussion with the patients during brief hospitalization, plus social work services for their relatives. There was no systematic psychotherapy. On the advice of the hospital staff, four of the seven moved from vulnerable occupations (with high exposure to drinking situations) to nonvulnerable ones. Each of the seven, after periods of complete abstinence of up to a year, resumed drinking that remained within the limits regarded as normal by their groups. None of them had been drunk even once in the seven to eleven years. All kept their drinking at a relatively mild level. Two of the men, whose excessive drinking prior to their hospitalization was believed to be symptomatic of chronic anxiety states, continued to be about as anxious as before, but their abnormal drinking patterns disappeared! In speculating on the meaning of his findings, Davies suggested that in some alcoholism it may be that treatable occupational and social factors, rather than irreversible biochemical or personality changes, are what tip the scales toward addiction. After presenting his startling evidence, Davies stated: "It is not denied that the majority of alcohol addicts are incapable of achieving Ďnormal drinking.í All patients should be told to aim at total abstinence." 7. Earlier he had pointed out that the seven who became social drinkers had been advised by him to refrain from all drinking. They chose to ignore the advice. Sixteen physicians, all with wide experience in treating alcoholics, were invited by the editor of the journal which published the Davies report to comment on it. 8. These points stand out in their discussion. Several suggested that the Davies study and other evidence in the literature indicate the need to question and perhaps revise the widely held assumption that no alcoholic can ever drink again in controlled fashion. A number of long-experienced therapists challenged Daviesí report. The possibility that his seven subjects were habitual heavy drinkers (Alpha alcoholics) but not "true addicts" was raised. Or perhaps they were "danglers" who sway around the demarcation line between alcoholic and nonalcoholic patterns. Under favorable conditions they were able to control their drinking; but under stress, a single drink might start a spree. Another respondent suggested that every alcoholic may have a critical blood alcohol level which reactivates his addiction. Daviesí seven had apparently kept their blood alcohol below this level. However, most alcoholics would prefer abstinence to drinking that the person cannot "feel." A number of commentators said that, in many years of practice, they had never known an alcoholic who was able to return to social drinking. Those therapists who had observed such cases agreed that the occurrence is exceedingly rare and that no one can predict which patients may have this capacity. Most important, there was general agreement that the goal of total abstinence is the only realistic and humane one in counseling with alcoholics. R. Gordon Bell, addiction specialist of Ontario, Canada, put it well:
For every alcohol addict who may succeed in reestablishing a pattern of controlled drinking, perhaps a dozen would kill themselves trying. At this stage of our knowledge and clinical orientation to the complex problems of alcohol addiction the only policy likely to prolong life consistently and improve human capacity to function in an intelligent manner is one of total abstinence. It is possible that we may eventually be in a position to pick out the small percentage of alcohol addicts who could begin a new moderate use of alcohol after a one or two year period of abstinence, provided that a satisfactory resolution of their personal and social problems had been achieved and the need for alcohol as a drug no longer exists. If this ever comes about, it will be the result of more comprehensive, prolonged clinical study than has been undertaken to date. Until we are in a position to predict who may be able to resume moderate controlled drinking, clinical studies of this kind should be carried on with a minimum of publicity. Otherwise the health and safety of a great many people could be seriously jeopardized. 9.
The possibility that in rare cases recovered alcoholics may reestablish the ability to drink in controlled fashion is largely an academic issue from the counselorís standpoint. Learning the secret of controlled drinking is the frantic desire of many drinking and partially recovered alcoholics. It is often their downfall! It would be utter folly, therefore, to suggest to an alcoholic that he might recover his ability to drink socially. Even to imply that a rare alcoholic does recover this ability is to foster a dangerous, unrealistic hope for the vast majority of alcoholic counselees, each of whom wants desperately to believe that he is that rare person who may recover control. The effect would be to strengthen the individual counseleeís resistance to facing the hard reality that he must learn to live without alcohol if he is to live at all. If an alcoholic in counseling mentions the Davies study or the more extreme views of Arthur H. Cain, [There is a wide gulf between the views of the scientific community, as reflected in the above discussion, and those of Arthur H. Cain in The Cured Alcoholic (New York: The John Day Company, 1964). He makes the extreme claim, based on a small number of cases, that it is possible for "any alcoholic, with the exception of alcoholic psychotics, to learn to drink normally" (p. 229). He asserts that 19 alcoholics he has treated have recovered the ability to drink normally. Since most of them, however, choose to abstain, their use as examples of reestablished control is open to serious question. He does not state how long those who do drink have been able to do so in controlled fashion. This is a crucial consideration since many alcoholics can control their intake for limited periods. Cainís entire approach is highly questionable; its impact on drinking alcoholics could be tragic.] the pastor should discover what meaning these have for the person and then move decisively to help him face reality, including seeing the lethal dangers of building his hopes on either the Davies or Cain studies. If an alcoholic seems to be using the Davies report as a defense against facing reality, he should be confronted gently but firmly with what he is doing, and helped to face three facts: (1) Most experts in the field of alcoholism agree that if controlled drinking among genuine alcohol addicts actually occurs, its incidence is very rare; (2) in the Davies study, control was possible only after a period of complete abstinence; and (3) control was possible only if the person kept his consumption at a non-intoxication level. It is well established that many alcoholics have tried to drink socially, after a prolonged period of abstinence, and have been unable to do so.
The long-range goal of counseling with alcoholics, then, is permanent abstinence leading to the development of potentialities for constructive living. Subsumed under this goal are four operational objectives which may be seen as overlapping stages of treatment: Helping the alcoholic (a) to accept the fact that his drinking is a problem with which he needs help; (b) to obtain, medical treatment; (c) to interrupt the addictive cycle and keep it interrupted by learning to avoid the first drink; (d) to achieve a re-synthesis of his life without alcohol. The pastorís role and uses of community resources vary at each stage of the recovery process, and from one alcoholic to another. The process and methods of achieving these goals will be described in the next two chapters.
Alcoholism is a complex illness. The minister should view the achievement of the goals of treatment as a team effort involving, as a minimum, a physician, an AA member, the alcoholic, and himself. Ministers who have attempted to "go it alone" in counseling alcoholics have found their effectiveness to be doubled or even tripled when they learned to utilize all of their communityís helping resources to the hilt. The pastor should think of himself as a team member with important functions with respect to all four operational goals. He should see himself as the coordinator of the team in providing help for those alcoholics who come to him, unless there is some other persons or agency which can fulfill this function more efficiently. The minister can maximize help to the alcoholic by adding to his own unique resources the specialized services of such resources as AA, Al-Anon, medicine, the alcoholic clinic or inpatient treatment facility, family services, etc. Most alcoholics seen by the minister require one or more of these forms of specialized help, in addition to pastoral counseling, in order to recover. Skill in relating the alcoholic to the particular helping resources he needs is an essential aspect of effectiveness in helping alcoholics.
Most clergymen are happy to refer alcoholics to those agencies and groups specifically designed to meet their problems. They recognize that AA, for instance, is tailor-made to meet the stresses and strains of alcoholism, and they accept the fact that alcoholism, as Harry Emerson Fosdick has put it, is like a stained-glass window in that it can best be seen and understood from the inside. They have accepted as their starting point a fact which has been well stated by Marty Mann:
The pastor will also have discovered that he, himself, cannot do an AA job on the alcoholic. He will see with his own eyes at meetings and at interviews he may witness that the man or woman who has actually been through the appalling experience of alcoholism has an edge on him that no substitute knowledge can replace. For one thing, the sober AA member is the embodiment of hope. He is the living promise that it can be done. He makes faith in the possibility of recovery a thing that can be seen and touched and heard -- himself. And, step by step, he can tell not how it can be done, but how he did it. 10.
Most pastors rejoice in the increasing availability of specialized agencies and groups to treat alcoholism. They say, in effect, "Thank God for AA." They realize that when they have made an effective referral of an alcoholic, they have actually made a great contribution to his eventual sobriety. Representative of the many alcoholics who have found their way to AA and happy sobriety through the help of their clergymen is Bob P., who has been sober in AA for several years. He recalls:
I was at the end of my rope. I used to joke about not going to church, saying that the last time I went was when I got married and Iíve never forgiven the church for that. But in despair I went to church. After the service I got the minister aside and told him I wanted to stop and couldnít. He said, "Iíll get in touch with a fellow who can help you." Thatís how I got in touch with AA. 11.
Some ministers tend to be too eager to refer the alcoholic. Out of the frustration of repeated failure, they are strongly motivated to shift responsibility to someone else. As any insightful minister knows, "referral" may be another way of saying, "Let George do it." The danger is that this attitude will be communicated to the alcoholic with whom it registers as rejection. Furthermore, by "passing the buck," the minister misses his opportunity to help the alcoholic in those unique ways of which he is capable. However, if the minister thinks of referral to a specialized agency, not as a shifting but as a sharing of responsibility, this tendency will be minimized.
Even if a minister were completely self-sufficient in his adequacy to help alcoholics, the prohibitive time element involved in counseling alcoholics is a practical limitation. An experienced pastoral counselor of alcoholics states: "Ordinarily one must see an alcoholic three or four times a week for the first few weeks, and then a couple of times a week for a month or two more, and then once a week for a considerable length of time." 12 Most ministers, though not as busy as they sometimes give the impression of being, work under heavy schedules. Intensive counseling with even a few alcoholics may involve time which the minister can find only by neglecting other important aspects of his work. Intensive counseling of alcoholics involves a considerable amount of frustration and emotional drain. A pastor has to be an unusually mature and secure person to take this in his stride.
For one or more of these reasons, most pastors are glad to make maximum use of community resources. This is true even of those who in the past have been effective working alone. One of the Yale ministers wrote: "Before 1949 I worked with alcoholics myself with a rather good degree of success. Since then I have found that it takes too much time and the clinic which has been established here is better. I either go with them to the clinic or feel certain they will go on their own."
Preparation for Counseling Alcoholics
In order to counsel alcoholics with any degree of effectiveness, one must have a basic understanding of alcoholism and of AA. He should have assimilated the kind of information presented in Parts I and II of this book and in Marty Mannís New Primer on Alcoholism. He should understand the nature of the sickness so that he can interpret it to the alcoholic and his family. And, very important, he must have some insight concerning the psychological attributes of alcoholics. These attributes provide the starting point of his approach to alcoholics. (Ideally, such basic knowledge about alcoholism and counseling alcoholics should be acquired by every minister during his seminary education.) So far as AA is concerned, every pastor ought to read and digest the contents of Alcoholics Anonymous, the "Big Book" (Alcoholics Anonymous Publishing, 1955), which can be obtained through any local AA group. He ought also to be familiar with some of the basic AA pamphlets such as "Alcoholics Anonymous in Your Community," "Medicine Looks at Alcoholics Anonymous," "AA, 44 Questions and Answers About the Program of Recovery from Alcoholism," "Is AA for You?" "A Clergyman Asks About Alcoholics Anonymous," "This is AA," "AA for the Woman," and "Young People and AA." Two additional AA books will help to broaden and deepen the ministerís understanding of this fellowship: Alcoholics Anonymous Comes of Age (New York: Harper & Bros., 1957) and The AA Way of Life, Selected Writings of AAís Co-Founder (New York: AA World Service, 1967). Both books reflect the insights of Bill W.
Second, preparation for counseling alcoholics should involve training in the general principles and techniques of counseling. Training in pastoral counseling should include not only intensive study of the literature and case seminars, but also clinical training in a hospital under a trained supervisor. (The Georgian Clinic in Atlanta has a clinical-training program for clergymen, which focuses on the treatment of alcoholism.) Equally valuable is a "training analysis" or a period of intensive counseling in which the pastor or pastor-to-be has an opportunity to resolve some of his own emotional problems with the help of a trained psychotherapist. The reason why this can be so valuable becomes apparent when one recognizes that many of the mistakes and lack of effectiveness in counseling are due, not to a lack of intellectual understanding of techniques, but to problems of interpersonal relationship. These problems stem from the pastorís own emotional quirks and blind-spots.
An invaluable form of training which is available to almost any minister who is motivated to sharpen his counseling tools is supervision of his counseling relationships. ĎWhat is required is the availability of a well-trained counselor or psychotherapist (pastoral counselor, chaplain supervisor, social worker, psychiatrist, clinical psychologist) who can be engaged to provide the supervision. Arrangements should be made for weekly meetings with the supervisor, continuing over at least a year and preferably two. The focus of the sessions is on case material, tape recordings, or verbatim reports which the minister brings from his counseling relationships. Groups of three to six clergymen sometimes arrange to meet as a group with a supervisor to reduce the cost to each participant. Ongoing supervision is one of the most effective ways of enhancing a ministerís counseling skills.
From a practical standpoint it is impossible for many pastors to have either clinical training or a personal analysis. It is important, as well as comforting, to recall that Giorgio Lolli has said that individuals who are relatively free from basic anxieties can have a beneficial influence on alcoholics, regardless of training. 13 Many pastors have done and are doing good counseling with alcoholics without having the advantages of the specialized training now available to some seminarians. This should not, however, cause us to forget that counseling alcoholics is difficult counseling in which the better oneís preparation, the greater oneís chances of effectiveness. Even those with good training have many, many failures in this field. For this reason, supervision of oneís counseling should be regarded as essential preparation for counseling with alcoholics.
The third type of preparation for counseling alcoholics is an acquaintance with the insights contained in the literature dealing specifically with this kind of counseling. There is a growing amount of this literature. Almost any issue of the Quarterly Journal of Studies on Alcohol contains an article dealing with the subject written by a psychologist or psychiatrist. Fortunately for the minister, there are several helpful discussions of pastoral counseling with alcoholics available. Thomas J. Shipp, a Methodist minister with wide experience in helping alcoholics, has produced a practical book entitled Helping the Alcoholic and His Family.14. Another useful volume is John E. Kellerís Ministering to Alcoholics. 15. Keller, a Lutheran minister with long experience in counseling with alcoholics, has served on the faculty of the Rutgers Summer School of Alcohol Studies. Both Shipp and Keller have been profoundly influenced by the philosophy and approach of AA. Alcoholism, A Source Book for Priests 16. provides some understanding of the Roman Catholic approach to alcoholism. Clifford J. Earleís book, How to Help an Alcoholic 17. and Seward Hiltnerís pamphlet, "Helping Alcoholics, A Guide for Pastors in Counseling Relationships with Alcoholics and Their Families," 18. though somewhat older than the Shipp and Keller books, are still useful resources for the pastoral counselor. An excellent general discussion of helping alcoholics is found in Marty Mannís New Primer on Alcoholism, 19. entitled "What to Do About an Alcoholic." Two other useful books are: Alcoholism, A Guide for the Clergy by Joseph L. Kellermann (published by The National Council on Alcoholism, 1963) and The Alcoholic by Fred B. Ford (published by Andover Newton Theological School, 1958). There is considerable overlapping among these books with respect to methods of counseling alcoholics. Nevertheless, since each writer brings his own unique experience and personality to the helping encounter, there are insights in each book that can contribute to the ministerís total preparation for counseling alcoholics.
Fourth, if a minister is especially interested in counseling alcoholics, he should attend one of the summer schools of alcohol studies. The majority last for a week, are held at state universities, and are cosponsored by the state alcoholism programs and the universities. The largest such school, held at the University of Utah, attracts over four hundred students from many of the western states. An international school, held at the University of North Dakota, involves the cooperation of several state and provincial (Canadian) alcoholism programs. The curricula of such schools is designed to be of particular usefulness to teachers, physicians, clergymen, social workers, law enforcement and probation officers, industrial leaders, directors of alcoholism programs, and other persons interested in alcoholism education, research, and rehabilitation. Advanced training is available at the Rutgers Summer School of Alcohol Studies, a three-weeks program of seminars and lectures. This was the first summer school of alcohol studies; some five thousand students from all over the world have attended since 1943 when it began at Yale. This school is one part of the Rutgers Center of Alcohol Studies, an interdisciplinary project which engages in wide-ranging research, publishes the Quarterly Journal of Studies on Alcohol as well as a variety of books and articles, and maintains the "Classified Abstract Archives of the Alcohol Literature" with over 10,000 entries on punch cards for automatic retrieval by topic. Researchers can quickly obtain abstracts as well as a bibliography on any topic which has been discussed in the scientific alcohol literature of the world. 20.
A fifth type of preparation for counseling alcoholics consists of becoming closely related to several AA members and to an AA group. In many ways this is the most important single form of preparation. Fortunately, since AA groups are now established in almost every center of population in this country, this form of preparatory experience is easily available to most ministers. All that is required is for the minister to make the effort to attend "open" meetings of AA with some regularity and thus to establish close relationships with key AA members. Attending AA meetings and talking with experienced members can allow the clergyman to learn many of the things about alcoholism and alcoholics which he needs to know in order to counsel effectively with alcoholics. (Attending Al-Anon meetings can serve in the same way, with reference to counseling with the spouses of alcoholics.) Since the ministerís relationship with AA is so crucial to his counseling effectiveness, it will be discussed in more detail in the section which follows.
Getting Acquainted with the Available Resources
One of the most important aspects of preparation for pastoral counseling of alcoholics is that of determining what resources are available for referral in oneís community, and of acquiring firsthand knowledge of these resources. Obviously it is desirable, though not always possible, to acquire this knowledge in advance of the need for it. A pastor may want to use a checklist such as the following:
REFERRAL RESOURCES AVAILABLE IN MY COMMUNITY
A physician who has an enlightened approach to the physiological side of
Hospitalization facilities. Where and how available to alcoholics.
A psychotherapist (psychiatrist or consulting psychologist) who understands
alcoholism and is sympathetic toward AA.
A Skid Row treatment center.
An enlightened Salvation Army installation, or rescue mission.
A Local Council on Alcoholism affiliated with the National Council on
An Alcoholic Information Center sponsored by the Local Council.
An Outpatient Alcoholism Clinic sponsored by a public or private agency.
An inpatient alcoholic rehabilitation center with a sound program of therapy, including AA and group therapy. (10 percent of state mental hospitals now have special alcoholism wards or programs.)
A rest-farm or similar institution which accepts alcoholics and is run on sound principles.
A half-way house for alcoholics.
Obviously, few ministers will have the time to do the research necessary to utilize such a checklist in full. It is presented here to suggest the range of possible resources. Actually, the local AA group or, where one exists, the local Alcoholic Information Center are the practical sources of reliable information concerning community resources. Seasoned members of AA will usually know such things as the practices of local hospitals, where to house homeless alcoholics satisfactorily, and which physicians or psychotherapists are effective in treating alcoholics.
How does one establish contact with the local AA group? It is usually listed in the telephone directory under "Alcoholics Anonymous." A phone call will put one in touch with the group secretary, the local AA clubhouse, or, in larger communities, the intergroup office. The person who answers can give information about meetings or make arrangements for the minister to come to the AA office for a discussion about AA in general or a particular alcoholic whom he is trying to help. AA groups welcome such professional inquiries. If AA is not listed in the telephone directory, one can get information concerning it from other clergymen or from local civic officials, especially the judge of the local court. If this fails, one can write the AA General Service Office, 305 East 45th Street, New York, New York 10017. This office will send the desired information, including the location of the nearest group. If there is no group nearby, he may wish to contact the office for assistance in helping to start a group. Twelve of the Yale ministers reported having been instrumental in helping to start one or more AA groups. A useful AA pamphlet is entitled "The AA Group, an Informal Handbook on How the Group Functions and How to Get One Started."
A practical discussion of how a pastor can work with AA and get help from it is found in an article by Marty Mann, executive director of the National Council on Alcoholism, entitled "The Pastorsí Resources in Dealing with Alcoholics." As a part of this article she gives some suggestions for starting an AA group:
There may be some towns where AA has not yet started. The pastor who finds himself in such a situation need not give up hope. It takes two alcoholics trying to get well to make a group, but only one alcoholic trying to get well to start a group. If the pastor knows even one alcoholic who he thinks really wants to stop drinking, he can very well help him to start an AA group. But he must always remember that it is the alcoholic who is starting the group, and not himself. In other words, he should remain in the background, ready to offer advice and assistance but not taking a prominent part in the activities of the one, two or three alcoholics who are trying to get started. His greatest usefulness will always be in providing new prospects for the first ones to work on, in spreading the word among his colleagues, and even in actually bringing the AA and the new prospect together. 21.
It is essential that a clergyman stay in the background of a group he helps start because if a group were too closely associated with a professional in religion, agnostic alcoholics would stay away. Further, if it were associated with a leader of a certain faith, alcoholics of other faiths might be kept away.
Ministers have had a fairly prominent role in helping to start new groups. For instance, the extensive work of AA in the St. Louis area grew from the efforts of a clergyman who shepherded several alcoholics, whom he was trying to help, up to Chicago to get a firsthand view of AA in action. These alcoholics started the first group in St. Louis. It is worth recalling that a clergyman had a small part in the actual beginnings of AA itself. It was a minister who gave Bill W. the name of Harriett S. who arranged the meeting of Bill with Dr. Bob.
The pastor who moves to a new community will wish to establish a working relationship with the local AA group at his first opportunity. This means getting acquainted with one, or better, several AA members who can be called on for assistance. The group chairman or secretary is a good one to know since he or she is usually an alcoholic of stable sobriety and sufficient experience in AA to be quite helpful.
It is impossible to overemphasize the value of actually attending several "open" AA meetings. This will accomplish several things that are important. It will show the AA members that the minister is interested in their work. It will give him an opportunity to establish rapport with the members he will need to call on for help with alcoholics at a later time. The coffee-cup fellowship after the meeting is an ideal time for this. Further, it will give the minister a greater understanding of both AA and of alcoholism. A pastor will wish to read the basic AA books and pamphlets, which can be obtained from the local group, but no amount of reading is a substitute for the experience of observing AA in action. Attending an occasional AA meeting is an important opportunity for the pastor throughout his tenure in a pastorate.
An important benefit of attending AA meetings is the lift and spiritual refreshment it gives the clergyman. In order to acquaint theological students in pastoral counseling courses with AA and to help them feel more at ease with alcoholics, the author asks his students to attend an open meeting of AA. Here are some typical reactions from students to their first exposure to AA:
It was one of the most meaningful spiritual experiences I have had. Godís love was truly present in this group of people.
There was a depth fellowship which I wouldnít mind being a part of.
One of the truly great spiritual moments in my life happened on Tuesday night at the local AA meeting!
To me both the honesty and the acceptance were overwhelming.
My desire was really to become a part of their fellowship which I canít because Iím not an alcoholic. Why canít the churches develop this kind of fellowship? Surely more people than alcoholics agonize over the waste of their lives. Some I am sure have descended into hell and have returned. What is this contentment with hollow forms, "a pile of broken images," to quote Eliot?
Once a working relationship is established, the pastor will discover that referral to AA is a two-way street. Alcoholics who learn to know and. trust him will come to him with their problems. Especially fortunate in this regard are the pastors who have AA groups meeting in their churches. Marty Mann summarizes what she considers the ideal relationship between a pastor and AA: "In short, the pastorís relationship with his local AA group should be one of reciprocity, of a free exchange of information and ideas on the particular case for which he desires help." 22.
One of the more outspoken alcoholics I interviewed told of a young minister who apparently tried to use the AA group as a means of obtaining members for his church. She declared: "I gave him a piece of my mind. I guess it wonít hurt him -- he wonít get drunk." Obviously, any pastor who gives AA members the feeling that he has ulterior motives has vitiated any effectiveness he might otherwise have had in working with them.
Since AA is the pastorís most valuable referral resource, it might be well to discuss certain reservations that some ministers feel regarding AA which inhibit their relationship with it. The Yale ministers were generally reluctant to mention what they regarded as faults. One wrote: "I can see what I believe to be some weak places in AA, but it is marvelous that it works. I think we had better just leave it alone and use it." Nearly all of the ministers were long on their praise of AA. Here are some sample comments which reflect a prevalent appreciation of AA among ministers: "The church could learn something about real fellowship from AA. The church should learn to be a warm, friendly place where alcoholics and others may find acceptance, strength, and self-confidence." "The church might learn to go after folks as AAís do, make allowance for their failures, and never give up." "The church needs to follow AA by turning from its enmity for the bottle to a friendship for the man." "The AA movement has captured the essence of evangelical Christianityís power." Another minister pointed out that the church could see in AA a demonstration of "the effectiveness of their practice of first-century Christianity."
Some of the Yale ministers did qualify their praise by mentioning what they regarded as imperfections in AA. Since these are representative of feelings held by many clergymen, it would seem important to discuss them, as a potential means of enhancing good relations between ministers and AA. The most common criticism of AA was that it has no concern for social drinking. Many ministers are baffled by the indifference on the part of AAís as to whether non-alcoholics do or do not drink. From the standpoint of AA, there are two reasons for this. First, most AAís are convinced that alcohol, per se, is not the basic cause of their problem. Rather, they feel that their unique response to alcohol is the cause. Second, it is official AA policy not to "endorse or oppose any cause" nor to be drawn into any public controversy. The wisdom of this policy has been amply demonstrated. The Washingtonians are a grim reminder to AAís of what might happen to their movement should they ever be diverted from their "one primary purpose . . . to carry its message to the alcoholic who still suffers." It is clear that AA can do its own work best by doing only its own work.
Several of the Yale ministers objected to the fact that AA does not emphasize Christ in its program. In this regard it should be remembered that AAís theological permissiveness is an important reason why it attracts many alcoholics who would shy away from orthodox religion. As one of the Yale ministers put it, "AAís great virtue is its ability to reach and help men and women who are outside the churchís sphere of influence." If AA is to serve alcoholics of all and no religious backgrounds, it must avoid becoming identified with any one theological position. This has become increasingly important as AA has become more international and intercultural in scope. Though the word "Christ" is not used in the AA approach, it would be difficult to find more Christlike concern and service than is found in AA at its finest. Further, a momentís reflection will be enough to remind a minister that "God as we understand him" is an apt description of the average church memberís actual (as distinguished from his creedal) faith. One might even apply the same to the faith of ministers.
The fact that AAís therapy sometimes results in the substitution of other compulsions such as gambling was mentioned by several of the Yale ministers. The implication of this criticism is that the therapy has not solved the underlying personality problem. In this regard, it should be remembered that no solution to any psychological problem is completely effective. All solutions -- religious and otherwise -- are successful only to a degree. To judge an approach adversely because it does not produce some radical realignment of personality is to forget the reality situation in our society in which radical solutions are simply not available to most people. As a practical consideration, it is true that in most cases where substitute compulsions appear, they are much to be preferred over alcoholism for both the alcoholic and for society.
Several ministers mentioned the clannishness, smugness, and lack of recognition of AAís limitations on the part of some AAís. These forms of behavior need to be seen as characteristics of relative newcomers in AA. As a member becomes more secure and less defensive, these characteristics which sometimes irritate outsiders tend to disappear. However, it is well to remember that the strong sense of belonging to an in-group is an essential part of the therapy of AA. The assumption sometimes made by AAís that "only an alcoholic can help an alcoholic" is, of course, not true. But it is true that an alcoholic has a special entrée to another alcoholic. The boost to the AAís self-esteem that comes from recognizing this fact, though it may result in a certain amount of smugness, is invaluable to the AAís continued sobriety. The attitude of superiority to professionals -- "AA did it when the doctors, ministers, and psychiatrists failed" -- can be understood and accepted in this light. It reflects adversely on the professionalís own self-esteem if he allows such attitudes to disturb him or his relationship to AA.
Some clergymen, particularly those steeped in the psychology of puritanism, are critical of the "bragging about past sins" and the swearing which AAís sometimes do in their talks. Although this reaction is essentially the clergymanís problem, it may be helpful to recognize the dynamics of this behavior. Verbalization of oneís past escapades before a sympathetic audience is actually a part of the cathartic process of working through oneís guilt feelings. The fact that a person can now tell in public of experiences which a few months before were too painful for him even to admit to himself is a sign of real progress. The fact that he can now see the ludicrous implications of behavior that was formerly only tragically serious helps to make it less likely that he will repeat it. Verbalization of alcoholic behavior is a means of identifying with the group. Dynamically, swearing is a symbol of something quite important -- viz., that this is not a "churchy" or pious group but a real he-man approach. These forms of behavior tend to diminish as a personís sober tenure in AA lengthens. However, the entertainment value of past escapades tends to perpetuate the behavior after it has fulfilled its dynamic function.
Some of the Yale ministers mentioned AAís lack of a preventive program as an imperfection. There is little justification for this criticism when one remembers that AA has dedicated itself to the specific and tremendous undertaking of helping alcoholics. This limited goal represents a legitimate and necessary division of labor. However, as we shall see in the chapter on prevention (Chapter 12), the indirect preventive effect of AAís influence is very powerful.
Several of the Yale ministers, as well as other clergymen whom I have known, have criticized AA because some of its members tend to make it a religious cult. It should be remembered that those who make AA their religion have found a measure of vital faith and service within its fellowship. As a recovered alcoholic, who is a devoted churchman, put the matter: "Many people find so much more acceptance in AA than in the church, they make AA their church." It is doubtful that those who make AA their religion would be in the church were AA not in existence. In many cases they would probably not even be alive. From the interview material of this writer, it is evident that AA is a bridge back to the church for 50 percent or more of its members. Official policy of AA encourages this. Thousands of ministers over the country could echo with enthusiasm the sentiments of one of the Yale ministers who wrote, "The churches should be grateful to God for the many fine, active members that AA has saved and sent into their fellowship."
We return now to our discussion of the referral resources which are available. If a minister is fortunate enough to live in one of the eighty-two communities (in thirty-two states) in which there is a local Council on Alcoholism, he should support its work as well as encourage his parishioners to do so. These councils, affiliates of the National Council on Alcoholism, operate Alcoholism Information Centers which disseminate knowledge aboutí the problem to anyone who is interested, including schools, churches, industry, the news media, and individual information-seekers. The central functions of the local councils are education and prevention, but their Information Centers also advise with alcoholics, relatives, and others concerning finding treatment in their community. The location of the nearest Alcoholism Information Center can be ascertained by writing the National Council on Alcoholism (2 East 103rd Street, New York, New York 10029). If a local council does not exist in oneís area, a pastor has an opportunity to do as several other clergymen have done and "spark" the formation of such a council. The National Council is glad to assist and advise a group of community leaders in such an undertaking. Five of the Yale ministers had been instrumental in helping to organize local councils.
The National Council on Alcoholism (NCA) and its local affiliates are valuable sources of information and guidance for the clergyman on any matters related to alcoholism. NCA is the national voluntary health agency in the alcoholism field. It "strives for the prevention and reduction of alcoholism through a program of education, community and industrial services and the promotion of research." 23.
Forty-four states and seven Canadian provinces have tax-supported alcoholism programs with three facets -- education, research, and treatment. The minister should check to see what resources are available through such a program in his state. If none exists, he may decide to encourage his state officials to consider establishing a program. The North American Association of Alcoholism Programs, founded in 1949, is the organization through which the network of tax-supported programs cooperate. With headquarters in Washington, D.C. (323 DuPont Circle Building, Washington, D.C. 20036), it provides information about public and professional alcoholism programs, as well as serving and representing its member-agencyís interests at the national and international levels. The goals of the Association are these:
To facilitate the exchange of information about education, research and treatment activities. To promote legislation and standards which will contribute to the care and control of alcoholism. To encourage professionals to deal with alcohol problems within their own disciplines, and to contribute new knowledge for better understanding and management of these problems. ĎTo encourage cooperation among all who are engaged in activities involving alcohol. 24.
The prospects for the rapid development of new education, research, and treatment resources throughout the country were brightened in 1966 by a rising tide of interest on the national level. In March, 1966, President Johnson became the first U.S. president in history to include a significant request regarding alcoholism in his Health and Education Message to Congress, stating:
The alcoholic suffers from a disease which will yield eventually to scientific research and adequate treatment. Even with the present limited state of our knowledge, much can be done to reduce the untold suffering and uncounted waste caused by this affliction. I have instructed the Secretary of Health, Education, and Welfare to: Appoint an advisory committee on alcoholism; establish in the Public Health Service a center for research on the cause, prevention, control, and treatment of alcoholism; develop an educational program in order to foster public understanding based on scientific fact; work with public and private agencies on the state and local level, to include this disease in a comprehensive health program. 25.
Later in 1966, the Secretary of Health, Education, and Welfare announced the Federal Alcoholism Program, including the establishment within the National Institute of Mental Health of a National Center for the Prevention and Control of Alcoholism. The program includes research, education, and professional training to combat alcoholism. 26.
In 1961, a substantial National Institute of Mental Health grant established the Cooperative Commission on the Study of Alcoholism. In October, 1967, the distinguished scientists who composed this group issued a significant volume, Alcohol Problems, A Report to the Nation (prepared by Thomas F. A. Plaut). This report presents a comprehensive approach to the solution of alcohol problems, including problem drinking, and makes specific recommendations for meeting the needs in the areas of treatment, research, prevention, and training personnel. It highlights the widespread neglect and crucial need for a nationwide policy and program of realistic action. The report provides the basis for a major breakthrough in the field of alcoholism.
A particularly encouraging development in treatment resources is the growth of industry-sponsored programs. Usually coordinated through the personnel and medical departments of a company, these programs have achieved remarkable recovery rates: from 50 to 80 percent of the alcoholic employees treated. From 1960 to 1965, the number of companies having alcoholism programs rose from 75 to 203. NCA maintains an Industrial Services Department to stimulate the growth of such enlightened programs. It is fortunate that humanitarian and economic considerations coincide in this area and that industrial leaders are increasingly recognizing that it is less expensive to provide treatment for alcoholic employees than to ignore the problem and to pay the costs of accidents, inefficiency, absenteeism, strained inter-employee relationships, and eventual retraining of a replacement for the untreated alcoholic.
Understanding the Medical and Psychotherapeutic Resources
In addition to possessing an overview of his communityís resources for helping alcoholics, a minister needs an understanding of the role of medical and psychotherapeutic resources in this helping process. This understanding allows one to draw upon these resources effectively and to interpret them to alcoholics who need them. In fact, one of the first questions a pastor should ask himself, when he comes into contact with an alcoholic, is this: Does this person need medical, psychiatric, or psychotherapeutic help, in addition to pastoral care and AA? To answer this question accurately, the minister may need to refer the alcoholic to a physician or psychotherapist who understands alcoholism and who can evaluate the personís need for particular therapies.
It will be helpful to the minister to acquaint himself with a more comprehensive discussion of the medical and psychological therapies than is presented in this volume. Chapter 2 of the Cooperative Commissionís report, mentioned above, includes an overview of treatment resources. Chapter 10 in Marty Mannís New Primer on Alcoholism offers a survey in non-technical language. More detailed and technical descriptions of the various therapies are found in R. J. Catanzaro (ed.), Alcoholism: The Total Treatment Approach 27. and
Ruth Fox (ed.), Alcoholism: Behavioral Research and Therapeutic Approaches. 28. An excellent survey of therapies by Ruth Fox, medical director of the National Council on Alcoholism, is presented in a journal article: "A Multidisciplinary Approach to the Treatment of Alcoholism." 29. The discussion that follows draws on this article at a number of points.
For our purposes, the medical and psychiatric therapies may be divided into three categories according to their purpose: (1) those therapies that aid in the physical rehabilitation of the person suffering from the effects of an acute binge and/or prolonged excessive drinking over many years; (2) those that help to keep the addictive cycle broken and thus maintain sobriety for sufficient time to allow other therapies to take effect; (3) those that aim at lessening the alcoholicís personality problems -- both those that contributed to the causation of his addiction and those resulting from the interpersonal chaos of progressive alcoholism.
Looking more closely at the first of these categories, it is well for the clergyman to remember that many alcoholics are in serious physical condition by the time they are ready to accept help. The medical problems are of at least two types -- problems related to the withdrawal of alcohol from the body (ranging from severe hangovers to delirium tremens and alcoholic hallucinosis) and problems of severe malnutrition (cirrhosis of the liver, polyneuropathy, Korsakoffís psychosis, and general malnutrition). The therapies for problems of withdrawal are usually short-term, as compared with the extended therapies which often are required to deal with problems of malnutrition.
An alcoholic who is coming off a protracted binge may suffer excruciatingly when alcohol is no longer present in his bloodstream. His painful "withdrawal symptoms" may drive him back to the source of chemical comfort, alcohol, and/or drugs. In a small percentage of cases, withdrawal symptoms may be fatal, unless the person is given proper medical attention. Detoxification procedures are available in progressive hospitals. I-laying such medical assistance may lay the groundwork for other therapies as well as save lives. Ruth Fox states: "Detoxification is aided enormously by tranquilizing drugs, so that these patients can now be successfully treated even in the open wards of a general hospital without causing any disruption of the normal routine of the hospital." 30. Most physicians prefer tranquilizers to the older sedatives of the barbiturate group in treating alcoholics. For a time it was believed that the tranquilizers were the "wonder drug" answer to the addictive problems posed by barbiturates. But subsequent experience has shown that at least some of the tranquilizers are definitely addictive. 31. Some alcoholics do become "hooked" on tranquilizers, even though these seem to be less addictive than the barbiturates. It is clear that caution is indicated in the use of any mood-changing drug by alcoholics and other addiction-prone persons.
Whether or not the alcoholic is hospitalized during the detoxification period (usually requiring only a few days), the chances are that he will need massive doses of vitamins and minerals to overcome the devitaminosis and general malnutrition resulting from "drinking oneís meals" over a long period. A high protein diet is also emphasized by some physicians to overcome the deficiencies of amino and fatty acids. 32. The process of physical rehabilitation includes treatment of any of the various diseases of malnutrition and general physical abuse which accompany prolonged alcoholic addiction. These diseases are by-products of alcoholism, and their treatment, which may be a long-term process, is an essential contribution of medical skill to full recovery.
Commenting on the use of brief hospitalization during the detoxification period, Fox states: "A plan of rehabilitation should be worked out before the patient leaves the hospital -- a plan which can be carried out in a doctorís office, an aftercare clinic, or an outpatient department especially geared to the alcoholic." 33. Such a plan should include whatever combination of therapies is required to help a particular alcoholic achieve stable sobriety and productive living. In most cases, regular attendance at AA should be an integral part of the plan of rehabilitation.
Turning to the second category of therapies, it is important to be cognizant of the fact that some alcoholics cannot halt their compulsive drinking for long, even with the help of initial detoxification procedures and continuing affiliation with AA. When a minister encounters an alcoholic who cannot stop drinking long enough for any therapy to be effective, he should suggest one or more of those stopgap measures which aim at providing just such a period of sobriety. A typical case is of a middle-aged business executive who, on a conscious level, desires to stop drinking. After prolonged heavy drinking culminating in a binge, he is in wretched condition physically and emotionally. Each time this happens, he is hospitalized, "boiled out," and restored to some extent physically through the skills of medicine. After a few days or weeks of post-hospital sobriety, he begins to drink again, as a result of anxiety and unconscious pressure, as well as his ability to rationalize and convince himself that "this time it will be different." Thus the cycle continues to repeat itself. In this case, the use of Antabuse interrupted the cyclical pattern and permitted group psychotherapy and AA each to play significant roles in the manís achievement of sobriety.
Antabuse, an American trade name for tetraethylthiuram disulfide, is a drug which deters the alcoholic from drinking and thus blocks the addictive cycle. The drug is also referred to as "disulfiram" in the alcoholism literature. One of the physicians who pioneered in the use of this drug in the United States, Ruth Fox, describes its positive values:
This is a medication given orally which interferes with the metabolism of alcohol so that even one drink will cause a toxic reaction of a shock-like nature. When not on disulfiram the alcoholic fighting the urge to drink may have to say "no" to this impulse several hundred times a day. When on disulfiram he needs to make but one decision, and that is on the taking of the pill. The effect lasts four days, which of course abolishes all impulsive drinking. Since the pill is taken every day, the ability to drink safely is well in the future. It also abolishes the preoccupation with drinking, which frees the mind for other things. Then, too, it helps the distressed family to know that the patient is even temporarily safe from alcohol. Most patients get a great lift from feeling that they can live without alcohol. 34.
Antabuse must be prescribed by a physician and should be taken under his careful supervision. It is not a "cure" for alcoholism, but it does provide a biochemical fence which holds back the addiction while other therapies have an opportunity to help the person learn to live without alcohol.
A word of caution may be in order. Nobody knows how many easy fortunes have been made by those exploiters of human misery who peddle some pill or potion which they claim will cure some burdensome ailment. Those afflicted by alcoholism, and their families, have been among those so exploited in the past. Perhaps our society is more sophisticated now and therefore less in need of caution about this danger. But gullibility springs eternal, fed by desperation and the need for hope and help. Therefore, it is still appropriate to emphasize in oneís educational work that there are no quick cures for alcoholism, no "pills for papaís coffee." 35. The goal of treatment, it should be pointed out, is not "cure" but arresting the progression of the illness by interrupting the drinking and helping the person to learn a new and more productive way of life sans alcohol. In the current scene, exploitation of alcoholics tends to occur in certain "drying out places" which offer little or no treatment of the addiction or opportunities for rehabilitative experiences. It is wise to view with some suspicion any institution or treatment program which is secretive about its methods of treatment of which makes what seems like exaggerated claims about the success of its treatment.
The aversion treatment, also called the conditioned reflex treatment, is another means of producing a period of abstinence. In contrast to Antabuse, the method is psychological rather than biochemical. In the United States this method is used relatively infrequently; whereas in England and Russia its use is widespread. An aversion to the smell, sight, and taste of alcohol is induced in the following manner. A drug (emetine or apomorphine) is administered, producing nausea and vomiting. Just before this occurs, the patient is given his favorite forms of beverage alcohol. After several such experiences, the person begins to associate alcohol and nausea. The conditioned reflex (a la Pavlov) thus established produces nausea whenever the person encounters alcohol. The duration of the aversion varies from person to person. In some cases it lasts for many years. Since conditioned reflexes tend to become weakened with the passage of time, periodic reinforcement of the aversion is required in most cases. Like the Antabuse treatment, this approach is adjunctive to other therapies; most programs using it couple it with group or individual psychotherapy. In some alcoholics, the craving for the anesthetic effects of alcohol is so powerful that they will continue to drink, in spite of the nausea, until the reflex is broken.
Another form of aversion treatment involves the use of posthypnotic suggestion to create the aversion to alcohol. Lincoln Williams, who uses hypnosis extensively with alcoholics, reports that the suggestion that the person will be indifferent to alcohol is sometimes successful, provided a deep trance can be achieved. He makes it clear, however, that hypnosis (including auto-hypnosis which he teaches his patients) is only an adjunct to psychotherapy. 36.
The third category of therapies consists of the various forms of psychotherapy. If it is true, as it seems to be, that one underlying cause of much alcoholism is intra-psychic conflict, then psychotherapy should be a useful approach. A small minority of sober alcoholics have found their sobriety via this path alone. (For example, Dwight Anderson gives an autobiographical description of such an experience in the second chapter of The Other Side of the Bottle.) But, by and large, psychotherapy alone has not been impressive in its degree of success with alcoholics. This is particularly true of psychoanalysis and psychoanalytically oriented psychotherapy. Such depth therapies are long and psychologically painful processes. The alcoholic, with his low frustration-tolerance, cannot tolerate the anxiety accompanying the therapy. When it becomes too painful, he retreats to his ever-accessible pain-killer, alcohol. (One of the interviewees told of having six martinis before each visit to his psychiatrist.) Heavy imbibing prior to therapy sessions negates the possibility of constructive therapeutic results. As if this were not enough, alcoholics defeat the therapy by missing appointments, arriving late, not paying their bills, and trying (often with self-defeating success) to deceive the therapist. The late E. M. Jellinek once said, in effect, that a therapist who had not tried to work with alcoholics usually recommends long and intensive psychotherapy when he encounters such a patient; but the therapist who has had some experiences in attempting to work with alcoholics will be more inclined to phone the nearest AA group. Too rapid transfer of responsibility to AA can constitute a problem in those cases in which the alcoholic needs both psychiatric help and AA.
If an addiction to alcohol is superimposed on severe mental illness -- a psychosis of the schizophrenic, manic-depressive or chronic brain-damage types -- it is essential to get the alcoholic to a psychiatrist. In such cases, inpatient treatment in a psychiatric hospital or in the psychiatric ward of a general hospital is usually indicated. In the vast majority of cases of alcoholism, however, severe mental illness is not involved, and psychiatric hospitalization is inappropriate. Most alcoholics do not need inpatient psychiatric treatment, and they are out of place with psychotic patients. (Inpatient facilities designed specifically for treating alcoholics serve a valuable function.)
Psychotherapy -- of a supportive and relationship-oriented variety rather than a depth, uncovering type -- has a crucial role in the treatment of some alcoholism. The time when it can be most effective, it should be emphasized, is after the alcoholic is sober for a substantial period of time. As indicated earlier, alcoholism is an illness of at least two levels -- the underlying personality problems and the addiction itself (the "runaway symptom," to use Tieboutís phrase). Psychotherapy may be of help in dealing with personality and relationship problems; it is usually grossly ineffective in halting the addictive cycle. The runaway symptom of drinking to overcome the effects of previous drinking must be interrupted before psychotherapy has a real chance of being useful. One alcoholic recalls: "I went to see the psychiatrist when I couldnít stop drinking. I was shaking and in a hell of a shape. He started asking me questions about my childhood. I thought to myself, ĎThe damn fool!í I didnít go back."
In choosing a psychiatrist to whom to refer an alcoholic, it is important to pick one who understands alcoholism and is appreciative toward the AA approach. It is particularly important that he be aware of the fact that the addiction must be interrupted before psychotherapy can be effective. Speaking as a psychiatrist, Ruth Fox declares:
I believe psychiatrists are in error in considering that alcoholism is merely symptomatic of an underlying personality disturbance and that treatment of the latter will cause the excessive drinking to cease. Unless the addiction itself is recognized and help given to the patient to attain sobriety, there cannot be a successful outcome. After sobriety has been attained, the patient may then be responsive to the various techniques of psychotherapy." 37.
Particularly tragic is the alcoholic who has been assured by a psychotherapist that his drinking is "merely a symptom of an underlying anxiety" and whose addiction (and general deterioration) steadily increases while he undergoes therapy ad infinitum. Having been told that his drinking is "purely symptomatic," and this by a highly trained, respected professional, the person is practically paralyzed in his ability to face the all-important facts that he is an alcoholic and must find a way to interrupt the addictive cycle.
It is noteworthy that the degree of underlying personality pathology and the type of therapy that is needed to treat it cannot be ascertained, in many cases, until the alcoholic has achieved sobriety and the psychological effects of protracted excessive drinking, per se, have been removed. Persons who appear to be very sick psychologically while they are drinking may prove to be relatively capable of coping with the demands of living after a period of sobriety.
Significantly, seven of the alcoholics interviewed had sought psychiatric help after achieving sobriety in AA; several others were contemplating obtaining such help. The cause of Frederick N., from Chapter 2, comes to mind. At the time of the interview he had been in AA for four years, and during most of the time he had been plagued by slips. Finally, in desperation, he went to see a psychiatrist who was also favorable to AA. As a result of the help he received in resolving some of his inner conflicts, he has enjoyed his longest period of continuous sobriety. He now feels that through his psychotherapy he has "gotten the program in AA."
If an alcoholic is severely psychoneurotic, he may need extensive psychotherapy in addition to AA. The aim of this therapy is to reduce the flood of anxiety which makes his hold on sobriety precarious and his life somewhat miserable when he is without the anesthetic effects of alcohol. If a person feels worse rather than better, after a month or two of sobriety, he probably could benefit from psychotherapy to deal with some of the inner sources of anxiety, guilt, and tension. Alcoholics with schizoid type personalities often are unable to feel comfortable with the degree of human closeness which is present in an AA group. Such persons may receive more help from a one-to-one relationship with a psychotherapist or counselor who will allow them to keep whatever distance is necessary to allow them to feel relatively safe.
Short-term therapy (a few weeks or months) with a psychiatrist who is knowledgeable in the area of alcoholism can be valuable for many alcoholics who do not require longer-term psychiatric treatment. Such short-term therapy aims not at deep underlying problems, but at helping the person do things that will improve his chances of achieving productive sobriety -- things such as accepting the fact that he is an alcoholic, learning how to face and handle his fears and resentments constructively, changing his ways of relating so that the guilt-isolation-anger spiral is not triggered so often. In short, the therapist helps the alcoholic begin to travel on the pathway which leads to a new way of life with dependence on relationships rather than alcohol. In the same direction, short-term marriage counseling can be useful in assisting the alcoholic and his wife to adjust to the demands of sobriety and to make their relationship more mutually satisfying and fulfilling.
Some of the most encouraging developments in the treatment of alcoholics are in the employment of group therapy methods. Ruth Fox states:
Group therapy is perhaps the most effective type of treatment for the alcoholic aside from AA. There is almost immediate identification and mutual support, which makes the alcoholic feel immediately accepted. The group represents a non-threatening, socially rewarding yet challenging atmosphere in which their many problems can be discussed. Problems about drinking, their jobs, and their families come up first, but soon they begin to discuss and show their deeper feelings of anger, resentment, sensitivity, guilt, distrust, loneliness, depression, fear, sense of inferiority, and worthlessness. When met with the sympathetic warmth and understanding tolerance of the group, many of these painful feelings are drained off.
The various interactions between members of the group, both negative and positive, give a chance for analysis of typical modes of reaction in the outside world.
Typical maneuvers or defenses, such as denial, rationalization, and projection become evident and are discussed in nontheoretical terms. Many strong and lasting friendships grow up in the group." 38.
The highest recovery rates are achieved in programs in which a combination of therapies, tailored to the particular needs of the individual, is used. 39. It is obvious from this that the treatment of alcoholism is a team job. Fortunate is the pastor who lives in one of the 220 areas in the United States and Canada in which alcoholic clinics are available for referral. In such facilities the "clinical team" consists of various combinations of the following -- an internist, a psychiatrist, a psychologist, a social worker, and, in a few clinics, a pastoral counselor and a recovered alcoholic who serves as a counselor. Each member of the team has special skills to bring to the common task of helping alcoholics recover. The internist is equipped to treat the physiological problems and administer Antabuse; the psychologist is trained to do testing through which the alcoholicís therapeutic needs can be evaluated, and he may be trained to do research and psychotherapy; the psychiatrist, being a medical doctor like the internist, can prescribe medication, but his unique skills are in the area of individual and group therapy and their relationship to drug therapies; the social worker may be trained to help the alcoholic work through his marital and vocational problems and do group as well as individual therapy; the social worker may also work with spouses; the pastoral counselor is specially equipped by training to help the alcoholic with his "spiritual" problems as these relate to his sobriety and his interpersonal relationships; he may also be trained to do group and marital counseling; 40. the recovered alcoholic on the team often can "reach" the less-motivated alcoholics and serve as a bridge-person to help them relate to AA. Few, if any, clinics have all these members on their team, but the principle of inter-professional teamwork is the heart of the working philosophy of these clinics. The cycle, when successfully implemented, accounts for much of their success.
1. "Alcohol Addiction -- A Problem for the Church," Information Service, Federal Council of Churches. Vol. XXI (April 25, 1942), No. 17.
2. Survey reported by E. M. Jellinek to the Yale Summer School of Alcohol Studies, July, 1949.
3. Report of a study undertaken by the Committee on Public Health Relations of the New York Academy of Medicine under a grant from the Research Council on Problems of Alcohol, 1947.
4. "Alcoholism in New Hampshire," report for the biennium ending December 31, 1948, p. 40.
5. "Pastoral Counseling of Inebriates," Alcohol, Science and Society, p. 439.
6. QJSA, March, 1962, pp. 94-1 04.
7. Ibid., p. 103.
8. See QJSA, issues of March, June, and December, 1963. The Davies report and the comments by the sixteen experts were later published in booklet form by the Rutgers Center on Alcohol Studies.
9. "Normal Drinking in Recovered Alcohol Addicts, Comment on the Article by D. L. Davies," QJSA, June, 1963, p. 322.
10. "The Pastorsí Resources in Dealing with Alcoholics." Reprinted by permission from the April, 1951, issue of Pastoral Psychology. Copyright 1951 by Pulpit Digest Publishing Company, Great Neck, N. Y.
11. Talk at an AA meeting in the New York City area.
12. Otis R. Rice, "Pastoral Counseling of Inebriates," p. 438.
13. Lecture at Yale Summer School, 1949.
14. (Engiewood Cliffs, N. J.: Prentice-Flail, 1963).
15. (Minneapolis: Augsburg Publishing House, 1966).
16. (Indianapolis: National Clergy Conference on Alcoholism, 1960).
17. (Philadelphia: The Westminster Press, 1952).
18. Distributed by the Division of Social Education and Action, United Presbyterian Church, Philadelphia.
19. Chapter 13, pp. 196-224.
20. For information about the Rutgersí program write: Rutgers Center of Alcohol Studies, Smithers Hall, Rutgers, The State University, New Brunswick, New Jersey 08903.
21. Pastoral Psychology, April, 1951, pp. 18-19.
22. Ibid., p. 15.
23. NCA Annual Report, 1965.
24. Flyer describing NAAAP, January, 1964.
25. Memorandum from NAAAP, March 1, 1966.
26. NCA Newsletter, Fall, 1966, pp. 1, 6.
27. (Springfield, Illinois: Charles C. Thomas, 1967).
28. (New York: Springer Publishing Co., 1967).
29. Reprinted from American Journal of Psychiatry, CXXIII (January, 1967), 769-78.
30. Ibid., p. 770.
31. Among the tranquilizers named as addictive by the AMA and the U.S. Public Health Serviceís Addiction Research Center are such familiar ones as Miltown, Equanil, Librium, Valium, and Doriden. (See Time, July 2, 1965, pp. 36-37.)
32. Fox, "A Multidisciplinary Approach," p. 772.
33. Ibid., p. 770.
34. Ibid., p. 773.
35. This phrase is the title of a chapter in Dwight Andersonís book The Other Side of the Bottle (New York: A. A. Wyn, 1950).
36. Fox, "A Multidisciplinary Approach," p. 775.
37. Ibid., p. 773.
38. Ibid., p. 773; see Ruth Fox, "Modified Group Psychotherapy for Alcoholics," Postgraduate Medicine, XXXIX (March, 1966), A-134 to A-140.
39. In one two-year follow-up study of 178 alcoholics, it was found that 24 percent of those who had received conditioned reflex therapy plus group therapy had improved; 26 percent of those who had had individual therapy plus group therapy had improved;
36 percent of those receiving hypnotherapy plus group therapy and 53 percent of those who had been given Antabuse plus group therapy showed improvement. (See Robert S. Wallerstein, Hospital Treatment of Alcoholism, Menninger Clinic Monograph Series, No.
11 [New York: Basic Books, 1957]).
40. At the Georgian Clinic much of the group therapy is done by well-trained pastoral counselors. A significant pilot project in training clergymen in the skills of helping alcoholics was launched in 1964, funded by a grant from the National Institute of Mental Health. For a description of the clinic see: "The Georgian Clinic, a Therapeutic Community for Alcoholics," QJSA, XXI (March, 1960), No. 1, 113-24.
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