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 12 The Prevention of Alcoholism
The church’s most important task, in relation to the problem of alcoholism, is prevention. In this area it has a tremendous mother lode of practically untouched opportunity. Organized religion has direct contact with over half the people in the country. This is more than any other non-governmental organization. If a substantial share of the religious organizations in our country would undertake an enthusiastic and realistic program of prevention, America’s fourth largest public health problem could be brought under control and hundreds of thousands of persons would be protected from becoming alcoholics.
Prevention is the only real solution to the problem. As things are now we are like Alice in Wonderland, running as hard as we can to stay at the same place. (Actually we are falling behind.) Alcoholics are being created wholesale while all the therapeutic agencies together are able only to treat them retail. As the great Japanese Christian, Toyohiko Kagawa, once put it regarding the problem of slums, this is like building a rescue station at the bottom of a cliff to help those who have fallen over, without working at the top of the cliff to keep others from falling. 1. There are 5˝ million alcoholics in the country, and AA has approximately 375,000 members. This means that AA, with its amazing effectiveness, has been able to reach slightly less than one out of every fifteen alcoholics in the country. That it has been able to achieve this in thirty years makes it a near miracle, but it is not the complete answer to the problem. Too many are falling over the cliff into the morass of the sickness of alcoholism each year. Somehow we must build a fence that will reduce the number of new alcoholics.
But what kind of fence is effective in preventing alcoholism? ‘What constitutes real prevention? We must have an answer to this before we can expect to approach the problem of prevention realistically. Our effort to point toward an answer will be divided into three categories. In Chapter 2 it was shown that the various causes of alcoholism operate on three levels: (a) the "soil of addiction," (b) symptom selection, (c) perpetuation of the addictive cycle. A comprehensive program of prevention can and should operate on each of these three levels of the alcoholic sickness. The three corresponding levels of prevention are: (a) prevention at the "grass roots," (b) prevention through the influencing of symptom selection, (c) prevention through early detection and treatment.
Prevention at the "Grass Roots"
The place where grass roots prevention must ultimately take place is at the point where alcoholism begins -- in the home. By exerting its educational influence in terms of the type of parent-child relationship that will satisfy the emotional needs of the child, the church can cut the roots of alcoholism. This is, of course, a long range program. . . . Some within the church will prefer to continue to engage in the less time-consuming business of manipulating symptoms -- for example, by attempting to shield people from becoming compulsive drinkers by making them compulsive non-drinkers.
The church is primarily concerned with making the life of abundance -- of full psychological and physical need satisfaction -- a reality in the lives of men. If it is successful in its primary task, it will help to deal the death blow to the status of alcoholism as a major area of human tragedy. 2.
As we saw in Chapter 1, approximately 6 percent of those who drink are vulnerable to alcohol addiction. In Chapter 2 we found that this 6 percent seems to be people who, because of inner conflict and anxiety, have an abnormal craving for the anesthetic effects of alcohol. Their personality problems and emotional immaturity constitute their Achilles’ heel which renders them vulnerable to alcoholism. Conversely, those who are fortunate enough to have relatively mature and well-integrated personalities have a much smaller chance of becoming alcoholic. Whatever the church can do, then, to promote mental, emotional, and spiritual health helps to prevent alcoholism at the grass roots. The prevention of alcoholism is thus related to the prevention of all other forms of social pathology.
Prevention of alcoholism at the grass roots is a gigantic task. Just how gigantic becomes clearer when one sees alcoholism as a symptom of the large areas of social malignancy within our culture. Leslie A. Osborn has said, "Big as it is, the problem of alcoholism opens into vastly bigger difficulties of our tangled and complex civilization." 3. The late Christopher Morley stated the same truth in another way when, in commenting on The Lost Weekend, he wrote: "It becomes almost the history of a whole era of frustration." 4. One can understand the depth and complexity of alcoholism, and therefore its prevention, by seeing it as a "tragic response to areas of tragedy in our culture."
We have seen that alcoholism is rooted in personality conflicts. In her illuminating discussion of inner conflicts, the late Karen Homey wrote:
"The kind, scope and intensity of such conflicts are largely determined by the civilization in which we live." 5. The civilization or culture into which an infant is born is channeled to him through the mothering adult in the early period of his life. The aspects of the culture, harmful or beneficent, which she is able to focus on the infant are determined in considerable measure by the way in which the culture was focused on her. Each culture tends to develop what Ruth Benedict has called its "configuration," 6. a certain pattern of attitudes and practices which control individual and group behavior and produce a nucleus of personality shared by most members of the culture. One configuration may make for emotionally satisfied and secure individuals who develop to a high degree their personality potentiality. Another culture’s configuration may produce patterns of child rearing, family life, interpersonal relations, social and economic life which produce a high degree of frustration and emotional warping in its members. The latter would lay the groundwork for maladjustments of all kinds. It would prepare the soil of addiction of which we have spoken above.
Our cultural configuration seems to provide amply for the conditions which cause the traumatization and emotional deprivation of personality. Because of the wide individual differences which are seen in any culture, these destructive attributes are focused with greater force on some than on others. The chart at the end of this chapter is a summation of factors found to be the most common in the parents of the alcoholics interviewed by the writer. It attempts to show the following in schematic form: column A, three cultural attitudes which are prominent in our "configuration" and in the personality patterns of the parents of the alcoholics; column B, the effect that these cultural attitudes have on the parents; column C, the way in which these effects tend to deprive the child of the satisfaction of certain vital needs; column D, the relationship between this deprivation of satisfaction and the psychological characteristics which are typical of alcoholics.
A child’s basic emotional need is for adequate love. This includes a sense of being wanted, of approval, of achievement, of belonging, of emotional warmth, acceptance, and nearness or relatedness to security-giving adults. Adequate love also includes the satisfaction of the child’s need for increasing autonomy, self-direction, and individual self-fulfillment. This implies accepting the child’s individuality, his physical drives, and his feelings. The maintenance of the balance between the child’s need for security and his need for independence is essential for emotional growth. David Roberts has written: "The child’s foremost need is an adequate supply of wise love. By ‘wise’ I mean steady and natural, instead of sporadic and forced; unsentimental and geared to growing autonomy instead of plaintive and smothering." 7.
If a child gets enough "wise love," love that is as free and accessible (and as important) as the air he breathes, he will become a healthy, loving, and self-reliant person, a person who does not need to use alcohol as a personality crutch. The three cultural attitudes mentioned on the chart -- authoritarianism, success-worship, and moralism -- all tend to impair the parent’s ability to give the child wise love. Thus they help produce the soil of addiction.
Unfortunately, Protestant churches have unwittingly contributed to the cultural configuration which has produced emotional damage. These past mistakes give Protestantism an added responsibility to contribute to those attitudes which produce emotional health. A group of chaplains of the Council for Clinical Training, men who have unusual opportunities in their work in mental hospitals and correctional institutions, to observe the mistakes of Protestantism, puts it this way:
American Protestantism has frequently made critical and tragic errors in its presentation of the Christian religion -- errors which have contributed to the emotional and spiritual conflict and immaturity in our people. Most of these errors find a focus in a stern, legalistic, absolute and Pharisaical moralism which is the characteristically American form of Puritanism. . . . Churches have had too little concern for understanding why people behave as they do and have been most relentless in their condemnation of acts contrary to social standards, with the result that many have responded with intense guilt feelings. - - . The guilty feel a sense of fear, loneliness and rejection and the result is various degrees of emotional disturbance. 8.
The report goes on to point out that the churches and their leaders have often propagated an unhealthy authoritarianism, resulting in fear, submissiveness, and immature dependence. Further, they have often made the mistake of saying directly or indirectly that sex is morally wrong.
We might add that the church has erred in that it often has made religion and the vitalities of life seem as opposites. Further it has often failed to create a healing fellowship which would attract people because it met their deep emotional needs. In his poem "The Little Vagabond," William Blake describes his contrasting feelings concerning what the church and the tavern have to offer in this respect:
Dear mother, dear mother, the church is cold
If the church had more often offered a fellowship that was "healthy and pleasant and warm" to children, youth, parents, and families, it might have done much more than it has toward preventing emotional ills, and it would have been unnecessary for persons to find their fellowship in taverns.
The chaplains quoted earlier go on to point out that the unhealthy attitudes and practices do not represent the "deepest and best in the Christian tradition or in the contemporary church." They state that the errors represent a departure from the spirit of the life and teachings of Jesus who was non-authoritarian in his dealings with people, understanding and not condemnatory to those involved in sin, and who reserved his anger for the legalists and moralists of his day.
The church’s first contribution to the prevention of alcoholism at the grass roots, by helping to prevent emotional conflict and illness, is to examine its own message and approach to people to make sure that they are in conformity with the principles of mental health and the best in the Christian tradition.
A church that is concerned about human values has no business allowing itself to be an agent in the perpetuation of harmful attitudes in the culture.
But it must go further than simply avoiding the doing of harm. It can put the weight of its educational program solidly behind the movement which aims at disbursing to people in general the precious discoveries of the social sciences in the area of healthy personality growth. The leaders of the Emmanuel Movement called for a "preventive psychiatry" which could help parents prevent the "wounds of childhood." Herein lies a tremendous educational opportunity for the church, with its natural entrée to families.
Let us see how this applies to alcoholism. The most cogent psychoanalytic explanation of alcoholism indicates that the emotional damage involved probably occurred in the very early life of the person -- during the period when the child’s primary way of relating to the outside world is oral. During the very early months of life the baby not only ingests food but also absorbs security and love through his body, and especially through his mouth. Several authorities in this field have indicated their conviction that alcoholism represents an attempt to return to the so-called oral stage of life. Whether or not this is true -- and the essential orality of alcoholism would suggest that it is -- the important fact is the one on which child-development authorities agree, that it is during the first six years that the foundations of personality are laid. What would happen educationally if the church would face the implications of the fact that the first six years are the most important years of a person’s life from the standpoint of character structure and personality? Would it not embark on a comprehensive program of parent education as a central focus of its work, making the discoveries of the psychologists concerning the emotional hungers of children, from the very dawn of life on, easily available to all its parents? Through such a program parents could come to see that healthy personality is "homemade" and that an ounce of mother is worth a pound of psychiatrist. Such parent education should put particular emphasis on helping the parents of infants to satisfy their babies’ oral needs, the babies being allowed abundant sucking and given cuddling as well as generous amounts of "t.l.c." (tender loving care). By helping parents to do that which they basically want to do but often cannot -- namely, raise children who are mentally, emotionally, and spiritually healthy -- the church would help to prevent alcoholism at its very roots.
Fortunately, an increasing amount of attention is being directed to the resources for enhancing mental health within the program of the church. For example, the author’s Mental Health Through Christian Community 10. was written to assist a local church in enhancing its ministry of growth and healing by releasing the mental health potentialities within its many-faceted activities. Each dimension of a church’s program -- worship, preaching, social action, the church school, church administration, small groups, family life, counseling, and the ministry of the laity -- has untapped possibilities for helping children, youth, and adults move toward greater personhood. Mental health seems to be "an idea whose time has come." Churches should be playing an increasingly vital role in the surge of interest in this area. As they do, they will be making a significant contribution in the area of prevention. These developments are completely consistent with the central concern of the church -- the growth of persons in ways that develop their God-given potentialities. It is well to remember that the words "health," "hale," "whole," and "holy" all come from a single Anglo-Saxon root. 11.
In discussing the role of the church in relation to alcoholism, several of the Yale ministers wrote some insightful words concerning prevention. Two of them pointed to the social dimension of the sickness when they wrote: "The Church’s job, I think, is to shed the searchlight of the Gospel on the causes of human misery of which alcoholism is a symptom"; and "We can prevent it by helping people learn how to live in a complex world." And a third wrote: "The best preventive measure for alcoholism is developing normal, wholesome personalities in tune with God."
As a matter of fact, the church through the years has made a real though unmeasurable contribution to the prevention of alcoholism at the grass roots. To the extent that it has succeeded in its objective of helping people to a sense of acceptance and belonging, to love and be loved, to find meaning in life and a faith for meeting death, it has prevented people from needing to escape into the pseudoworld of alcoholism. No one can know how many people might have become alcoholics but didn’t because of the faith and fellowship which they found in their church. By utilizing the newer insights of the mental health movement, the church can make a much larger contribution in this area in which it has long been serving.
Prevention Through the Influencing of Symptom Selection
Some will say that attempting to prevent alcoholism at the grass roots is so large an undertaking as to be almost Utopian in nature. There is some truth in this point of view, and we should never allow our concern with the long-range and fundamental program of prevention to deter us from also working to attain the nearer preventive goals. As a matter of fact, there is a danger from the educational standpoint involved in the grass-roots approach. The danger is that, having heard that "emotionally healthy people don’t become alcoholics," the individual will assume that he is not a potential candidate for the sickness. Consequently, he will become overconfident in his relationship with alcohol.
In order to counteract this danger, it is important to emphasize certain facts as we push for grass-roots prevention: First, that one need not be aware of severe neurosis or emotional instability to become an alcoholic. Many of our deep psychological problems are hidden and disguised even from ourselves. The emotional damage which underlies alcoholism seems to have happened at a very early age, in many cases, and has been overlaid by many strata of comparatively normal personality adjustment. Alcohol seems to reactivate these buried problems. Few, if any, of the people who become alcoholics think that they are neurotic or pre-alcoholic before they enter their addiction. Second, at the present stage of psychological knowledge it is impossible to predict with any degree of accuracy just which six people out of any one hundred drinkers will become alcoholics. Until it is possible, it is wise to accept the warning contained in the title of a pamphlet which came to my desk, "You, Too, Can Be an Alcoholic."
We know that there are factors other than the possession of healthy personalities which help prevent some people from becoming alcoholics. We know, from Chapter 2, that even very neurotic people will usually not become alcoholics if they live in a sub-cultural group which makes drinking or drunkenness unattractive. We know that if a person lives in a group that encourages the use of alcohol to excess and as a means of interpersonal adjustment, he may become an alcoholic even if he has a relatively adequate personality. It is clear that the culture factors which control inebriety have definite implications for the prevention of alcoholism.
Robert Straus, Sociologist on the faculty of the University of Kentucky Medical School, has said regarding alcoholism, "Those who drink constitute the ‘exposed population’ from an epidemiological standpoint." 12. It is true, as those who advocate total abstinence hold, "If you don’t drink you won’t become an alcoholic." Let us evaluate the strengths and limitations of total abstinence as a means of preventing alcoholism. If an individual decides that it is smarter not to drink, he is detaching himself from the "exposed population" so far as the sickness of alcoholism is concerned. One may well make this decision in the light of these facts:
1. One person in fifteen who drinks will become a problem drinker. If one is a male, the risk is much higher. (Approximately 80 percent of all alcoholics are males.) This is the realistic danger that all drinkers should face.
2. No one really knows whether or not he is a potential alcoholic.
3. Even if one is not a potential alcoholic, abstinence may prevent one from having an adverse influence on others who may be. This is especially applicable to influence on children and youth.
On the other hand, it is well to recognize the limitations of the abstinence position, if it is regarded as the only approach to the prevention of alcoholism. For one thing it does not provide protection for the majority of people who do not hold to this position and who are not likely to be persuaded in the foreseeable future. The Mulford Study (see Chapter 2) showed that only 37 percent of Protestants and 11 percent of Catholics practiced total abstinence. Of the 15,747 college students surveyed by Yale, 74 percent use beverage alcohol. In spite of the abstinence teachings of their church, 70 percent of Methodist students drink. Of the 26 percent who abstain, slightly less than one third do so because drinking is contrary to religious or moral training. 13. These facts do not, of course, invalidate total abstinence as a tenable position, but they do show that it cannot be the only approach to the problem.
Secondly, if it is assumed that, so far as alcohol is concerned, there are only two groups ethically speaking -- drinkers and nondrinkers -- an unfortunate splitting of the ranks occurs. Those who hold very strongly to the abstinence position often forget that there is another group who are as opposed to excess as they are and who might be allies in developing sanctions against drunkenness. From our study of the Jewish culture we know that such sanctions are extremely effective in preventing alcoholism. We also know that unified sanctions against drunkenness do not exist in American life in general, and that their absence contributes to the high rate of alcoholism. Those who are compulsive in their espousal of abstinence tend to drive the real moderationists -- whose existence they do not recognize -- into identifying themselves with those who use alcohol to excess.
Even the churches tend to divide ranks along these lines. The churches in the temperance tradition have tended, on the one hand, to regard their position as the only "Christian" one, to misunderstand the nature of alcoholism, to divide all persons into two groups-drinkers and nondrinkers. They have tended to ignore the more fundamental problem in alcoholism -- the sick personality -- which should have been their primary concern as Christians. On the other hand, the non-temperance churches, partly as a reaction to the temperance churches, have tended to overlook the realistic dangers of the use of alcohol in our neurotic culture, to treat drinking as if there were no moral problem involved, and to ignore the seamy side of drinking. Both sides have oversimplified the ethical complexities of the problem. Thus the churches, which should have been helping to form unified cultural sanctions concerning the use of alcohol to excess, have contributed to the confusion.
From the standpoint of potential alcoholics, the abstinence position if compulsively held has another limitation. This is the "forbidden fruit" atmosphere which can be especially dangerous for young people who are in the rebellious period of adolescence. A considerable number of the alcoholics I interviewed had come from rigidly prohibitionist homes and attributed their early excess in part to a reaction against the taboos of their early lives. It was apparent that Prohibition affected some pre-alcoholics in the same way.
J. H. Skolnick, using data from the College Drinking Survey, 14. compared the drinking behavior of students of various religious affiliations. He devised a "social complications" measure, to ascertain the amount of problem behavior connected with the drinking of each group. He found that 39 percent of Episcopalians, 34 percent of all male students in the College Drinking Survey, and only 4 percent of Orthodox Jewish students reported social complications related to their drinking. In contrast, 50 percent of the Methodist students and 57 percent of the nonaffiliated (with any religious group) students from abstinence backgrounds reported social complications. 15. (All percentages are of drinking students in a particular group.) The Jews had the highest proportion of students who drink at home and whose most frequent drinking companions are their families. The Methodists had the highest occurrence of initial drinking experiences in automobiles or bars and current drinking in commercial establishments among small male groups.
The crucial issue of why the abstinence orientation seems to promote problem drinking behavior is explored by Skolnick. He concludes, "Abstinence teachings, by associating drinking with intemperance, inadvertently encourage intemperance in those - . . who disregard the injunction not to drink." 16. The fact that the students from abstinence backgrounds frequently begin drinking outside their homes, without their parents’ knowledge and in opposition to their religious teachings (which would tend to arouse guilt), and with no ethical guidelines from their churches to distinguish responsible from irresponsible drinking, also may contribute to the high incidence of problem drinking behavior.
Parents who choose personal abstinence will help their children most by doing so in a matter-of-fact manner, without making it a great issue. A study of the drinking habits of college students showed that the most important factor in determining these habits is parental example. Many, but of course not all, of the young people were found to drink (or abstain) like their parents. What the parents taught on the matter was of little importance compared with what they actually did. 17. The study suggested that confliots in sanctions in the home concerning the use of alcohol is a factor which seems to encourage incipient alcoholism in young people. 18. Further, the attitudes and practices of the parents were much more influential on the young people’s thinking and action than were the teachings of their schools or churches.
The Jewish culture can provide valuable insights concerning the prevention of alcoholism through influencing symptom choice. In Chapter 2 we saw that most Jews drink, that very few become alcoholics, even if they are emotionally disturbed. This is an example of the control of cultural sanctions against drunkenness. What can we apply from the Jewish situation to American drinking patterns in general? It is not realistic to say that all that is needed to prevent alcoholism is to do as the Jews do. The Jewish attitudes and sanctions are a part of the total milieu of the religio-social community which is Judaism and which is the product of many centuries of historical development. It is not possible to transplant one segment of this and expect it to thrive in a different environment. Cultural sanctions have deep roots, and it is not possible to create them by any short-term educational procedure.
It is possible to learn from the Jewish group the effectiveness of unified sanctions against drunkenness. It is also possible for individuals and institutions -- in this case, the church -- to exert their influence in the direction of a gradual growth of such sanctions in American life. The sickness conception of alcoholism is the best foundation for such a development. If it were generally recognized that habitual drunkenness is a symptom of a disease that is both personally and socially devastating, and if it were generally accepted that frequent use of alcohol as a means of interpersonal adjustment can lead to alcoholism, a new climate of public opinion would come into being. Instead of accepting and even encouraging drunkenness, cultural attitudes would exert pressure against it. More of this in the third section.
Closely related with this is the matter of deglamourizing drinking. Of course this is much easier said than done. But the fact is that people, especially young people, do not have an opportunity to make a free choice about drinking. On every side drinking is presented as an indispensable part of gracious and fashionable modern living. Their choice is made under pressure from their normal desire to partake of this living. One need not believe in the prohibition of all drinking or even in abstinence for oneself to be concerned about reducing this pressure, which undoubtedly causes many who cannot handle it to use alcohol through social conformity. A candid look at America’s drinking patterns reveals a measure of truth in the quip, "If alcoholism is a sickness, a lot of people are trying to catch it." The unrestricted, high-pressure advertising of a product which will produce untold tragedy for 6.7 percent of those who use it has ethical implications which our society must face. Related to this are the pressures in American life which associate ability to drink and "hold one’s liquor" with masculinity and being "in." These pressures have an unfortunate effect on teen-agers and are one reason why many alcoholics have trouble accepting the truth about their sickness so that they can get help. [ Note: The Cooperative Commission on Alcoholism, in an illuminating discussion of prevention, makes these proposals for modifying drinking patterns and thus lowering the rates of alcoholism: First, reduce the emotionalism associated with drinking; second, clarify and emphasize the difference between acceptable and unacceptable drinking; third, "discourage drinking for its own sake and encourage the integration of drinking with other activities"; fourth, "assist young people to adapt themselves realistically to a predominantly ‘drinking’ society." (See Alcohol Problems, A Report to the Nation, pp. 136-52.)]
The late E. M. Jellinek did a cross-cultural comparison of the relation between drinking practices and alcoholism rates in 25 countries. His findings demonstrate the relation between the two types of prevention described above. Diagram #2 at the end of this chapter delineates his major conclusion: 19.
The top bar represents the degree of psychological disturbance in the individuals in a given population, producing vulnerability to alcoholism. The grossly disturbed persons are represented by the "high" (right) end of the continuum, the mentally healthy by the "low" end of the bar. The lower bar represents the degree of acceptance of heavy drinking as "normal" behavior in a particular culture or subculture. The "high" end represents societies in which heavy drinking is viewed as normal (for instance, France); the "low" end those societies or groups in which normal behavior is seen as including only abstinence or extreme moderation (for instance, the Jews).
As the arrows indicate, Jellinek found that in cultures in which there is non-acceptance of heavy drinking, persons who become alcoholics tend to be drawn from those in the population suffering from a high degree of psychological disturbance. In contrast, in cultures in which heavy drinking is seen as normal behavior, some persons from all degrees of mental health or illness (i.e., all degrees of psychological vulnerability) become alcoholics.
Jellinek summarized his study in what he described as his "working hypothesis":
In societies which have a low degree of acceptance of large daily amounts of alcohol, mainly those will be exposed to the risk of addiction who on account of high psychological vulnerability have an inducement to go against the social standards. But in societies which have an extremely high degree of acceptance of large daily alcohol consumption, the presence of any small vulnerability, whether psychological or physical, will suffice for exposure to the risk of addiction. 20.
The importance of the implications of this study for an understanding of prevention cannot be overemphasized. If one lives in a culture or closely knit social group in which there are strong sanctions against heavy drinking and drunkenness, the chances of becoming an alcoholic are relatively small, even if one is markedly disturbed psychologically. Conversely, if one lives in a heavy-drinking culture or group, one can become an alcoholic with relatively minor psychological problems. Thus, alcoholism can be prevented by reducing the degree of general psychological vulnerability in a population (prevention at the grass roots) and/or by education which reduces drinking, especially heavy drinking and drunkenness (prevention through influencing symptom selection).
Prevention Through Early Detection and Treatment
In spite of the many new resources for helping alcoholics, countless sufferers from this illness are reaching treatment only after they have wasted what should be the most productive and creative years of their lives. Thousands of others are dying without ever reaching or becoming receptive to effective treatment for their total problem. Any seasoned minister could give examples of such tragedies from his pastoral experience. Somehow we must devise better means of early detection and motivation-to-treatment of the majority of alcoholics whose problem is still hidden. The importance of early treatment is highlighted by the now well-established fact that those who have treatment while they are still holding jobs and with their families have significantly higher recovery rates than do those who have lost these key incentives to recovery. In Chapter 8, certain methods of bringing hidden alcoholics to help were explored. The importance for prevention of the utilization of such techniques cannot be overemphasized. To use them with maximum effectiveness, one must understand the forces which tend to keep alcoholics in hiding and away from the help that is available.
In Chapter 2 we saw that one group of etiological factors operates on the level of perpetuating the addiction once it is established. It is these factors that make it necessary for the sickness to grind on and on through years of agony before the person is open to help. To the extent that these factors can be altered and early treatment instituted, the alcoholic will be prevented from having to go through the terminal period of suffering. What are the factors and what can be done about them? In many cases it is a combination of a lack of knowledge concerning the early signs of alcoholism, plus the voluntaristic, moralistic attitude toward alcoholism still prevalent in our culture which allows the sickness to go so long untreated.
The fact is that alcoholism slips up on many people. The loss of control is usually insidiously gradual and therefore difficult to recognize, particularly in oneself. Everyone has at least a little magic in his attitude toward himself -- magic of the "It can’t happen to me" type. This, plus the power to rationalize, so that one gives normal reasons for one’s abnormal behavior, causes many to fool themselves for years about alcoholism. A contributing factor in this process is widespread ignorance concerning the danger signals of early alcoholism. How often the alcoholic or his relative says in retrospect, "If I had only been aware of the early symptoms, I could have looked for help rather than trying to fight it through myself." Overcoming this ignorance is an educational task in which the church should play a part.
Let us review some of the danger signals. A person is in the early stages of alcoholism or is in serious danger of entering them:
1. If he uses alcohol rather than his personality resources as a persistent means of solving his problems.
2. If alcohol holds a prominent place in his thinking and the planning of his activities.
3. If he uses alcohol as a persistent means of gaining social confidence or courage.
4. If he spends money for alcohol which he really needs for the necessities of life.
5. If he is defensive about how much or when he drinks.
6. If he gulps drinks, or drinks in secret.
7. If he drinks in the morning to cure a hangover, or to "pep up" for the day.
8. If he has blackouts when he is drinking.
9. If his drinking behavior is in defiance of the drinking standards of his important social or fellowship group.
10. If he begins to feel "normal" only when he has alcohol in him.
11. If his drinking interferes with his homelife, his job, his social life, or his health.
Early detection and treatment are dependent on more than simply the knowledge of early signs. They depend even more on whether the person can apply his knowledge to himself. Even if a person has accurate knowledge about the early signs, he can still rationalize and say: "These don’t apply to me. I have very good reasons for my drinking behavior. I can quit when I want to." The fact is that when an alcoholic can stop, he usually doesn’t want to stop, and when he wants to stop, he can’t. What is involved, then, is a change in basic attitudes toward the problem.
Why does the alcoholic rationalize and resist the idea that he might be an alcoholic? One of the chief reasons is because he lives in a culture that traditionally has regarded inebriety largely as a matter of morals and willpower, and still does to a considerable degree. The survey cited in Chapter 2 showed that a majority of Americans accept the fact that alcoholism is in some sense an illness. However, in the thinking and feeling of a large proportion of these, an underlying moralism still blocks full acceptance of the sickness conception. In spite of all that has been written and said about alcoholism being a compulsive illness and an addiction, many Americans still think of it in moralistic, willpower terms. This lack of deep-level acceptance of the sickness conception is naturally internalized by the alcoholic in his thinking about himself.
As long as the alcoholic thinks of his trouble as essentially a matter of willpower, he will tend not to seek help. To do so would be an admission that he is weak or morally corrupt. But as soon as he accepts the sickness conception and applies it to himself, he will tend to take action appropriate to a sickness -- get help. Those whose attitudes help perpetuate the moralistic conception of alcoholism are thus unwittingly responsible for pushing alcoholics deeper into the dark morass. As Marty Mann puts the matter:
Up to now the alcoholic has been made to feel shame if he could not handle his drinking by himself. Our goal must be to reverse that: to make him feel shame at riot seeking help for his illness. If he himself really comes to believe that he has a disease, the chances are greatly enhanced that he will seek treatment for it. Thousands of cases have proved this. 21.
That alcoholism is an illness has been known for a long time. Ulpian, a Roman jurist who lived in the second century, urged that inebriates be treated as sick persons. In a paper published in 1785, Benjamin Rush, a signer of the Declaration of Independence and foremost physician of his day, referred to alcohol addiction as a disease. In 1804 a Scottish physician, Thomas Trotter, wrote a doctoral dissertation in which he said: "In medical language, I consider drunkenness, strictly speaking, to be a disease." 22. Around the year 1820, Lyman Beecher sat beside the bed of a young parishioner, a chronic alcoholic who was dying. Later Beecher said, "I indulge the hope that God saw it was a constitutional infirmity, like any other disease." 23.
In spite of Beecher’s early recognition and that of some others like him in the church, there has been considerable resistance on the part of religious leaders to the sickness conception. This has been especially true among the temperance denominations. Until the sickness conception is generally accepted, realistic prevention on a large scale will be very difficult. If a religious group helps to foster the general acceptance of the conception, it promotes the following constructive conditions: (1) Community pressures are mobilized in the direction of motivating the alcoholic toward help rather than away from it, in the early stages of his illness. (2) A major obstacle to early treatment is removed from the mind of the alcoholic himself. (3) He will have community support rather than rejection during and after his treatment. (4) Society at large will come to recognize that it is to its advantage to provide adequate facilities for treating the alcoholic.
If one has doubts about the effectiveness of a wide dissemination of realistic knowledge about alcoholism in encouraging earlier treatment, he has only to look at what has happened in AA. Each year from almost the beginning, the average age level seems to have declined in AA. The reason for this seems to be that AA itself, by its dramatic success based on the treatment of alcoholism as an illness, has had a tremendous educational impact. Through its influence, many younger alcoholics came to recognize their trouble and seek help. The existence of "Thirty-five and Under" groups and the AA pamphlet "Young People and AA" are both indications of what has happened. AA has and will continue to have a leavening influence on our whole society, so far as a more enlightened view of alcoholism is concerned.
Prevention through early detection and treatment is directly related to a fourth form of prevention -- prevention through helping the children of alcoholics. In Chapter 2, a study by Jellinek was cited as evidence of the fact that many alcoholics have alcoholic parents. It is probable that between 20 and 30 percent of children of alcoholics eventually become alcoholics because of the emotional damage inflicted on them in their early lives. Since children of alcoholics have a high degree of vulnerability to the illness, they constitute an important target group for prevention! Such prevention may take one or more of three forms. First, early treatment of the alcoholic parent prevents the extreme emotional trauma to the children of the advanced stages of the illness. Second, helping the nonalcoholic spouse cope more effectively with her parental role, using methods described in Chapter 11, can diminish the emotional malnutrition suffered by the children. Third, direct help of the children, by pastoral counseling, Alateen group participation, and the other means described in the last chapter can enhance their mental health and thus make them less vulnerable to alcoholism a decade or so hence. These forms of direct and indirect help for the alcoholic’s children are ways of preventing the various personality illnesses and social deviancies to which such children are prone. As a focus of preventive activities, it combines prevention at the grass roots and prevention through early treatment.
CHART OF CULTURAL ATTITUDES:
GRAPHIC: DRINKING PRACTICES AND ALCOHOLISM:
1. E. 0. Bradshaw, Unconquerable Kagawa (St. Paul, Minn.: Macalester Park Publishing Co., 1952), p. 90.
2. H. J. Clinebell, Jr., "American Protestantism and the Problem of Alcoholism," Journal of Clinical Pastoral Work, II (Winter, 1949), 214-15. Used by permission.
3. "New Attitudes Toward Alcoholism," QJSA, XII (March, 1951), 60.
4. Charles Jackson, The Lost Weekend (New York: The New American Library,1949), Preface.
5. Karen Homey, Self-analysis (New York: W. W. Norton & Co., 1942), p. 27.
6. Ruth Benedict, Patterns of Culture (New York: Houghton Muffin Co., 1934).
7. Psychotherapy and a Christian View of Man, p. 65.
8. "American Protestantism and Mental Health," journal of Clinical Pastoral Work, I (Winter, 1948). Used by permission.
9. Quoted in Charles Clapp, Jr., Drinking’s Not the Problem, How You Can Help a Potential Alcoholic (New York: Crowell and Co., 1949), p. 62.
10. (Nashville: Abingdon Press, 1965).
11. Paul B. Maves, ed. (New York: Charles Scribner’s Sons, 1953), p. 1.
12. From a paper presented at the annual meeting of the National Committee on Alcoholism, March 18, 1955.
13. Harold A. Mulford, "Drinking and Deviant Drinking, U.S.A., 1963," p. 637. The Yale survey of college students is reported in Straus and Bacon, Drinking in College. See pp. 46 and 65 for the facts mentioned.
14. Conducted by the Yale Center of Alcohol Studies, 1949 -- 1951.
15. J. H. Skolnick, "The Stumbling Block: A Sociological Study of the Relationship between Selected Religious Norms and Drinking Behavior," Yale University Thesis, 1957.
16. J. H. Skolnick, "Religious Affiliation and Drinking Behavior," QJSA, XIX (1958), p. 470.
17. Drinking in College, p. 85.
18. Report by R. Straus in a speech before the annual meeting of the National Committee on Alcoholism, March 18, 1955.
19. This diagram is similar to the one which Jellinek used to illustrate the lecture in which he reported on this study at the Yale Summer School of Alcohol Studies, 1961.
20. The Disease Concept of Alcoholism, pp. 28-29.
21. New Primer on Alcoholism, pp. 198-99.
22. Taken from a history of the sickness of alcoholism by H. W. Haggard and E. M. Jellinek, Alcohol Explored (Garden City: Doubleday & Co., 1942), p. 142.
23. F. W. McPeek, "The Role of Religious Bodies in the Treatment of Inebriety in the United States," Alcohol, Science and Society, p. 406.