The Prevention of Alcoholism
By William D. Silkworth, M.D.
New York City
The “Blue Book” -National Clergy Conference on Alcoholism, 1960
Alcoholism, because it is such a profound social problem, has become the subject of considerable scientific and lay research. Many theories are being advanced as to what it is and why alcoholics are the way they are. It has become a very lucrative source of discussion for many.
Out of a phantasmagoria of conflicting and often esoteric theories based on scant clinical findings, two sharply defined but quite divergent diagnoses have been arrived at.
The first, that the disease is purely physiological, a glandular malfunction caused by a disturbed metabolism.
The second, that it is purely psychological -alcoholics are essentially inadequate, mentally underdeveloped individuals, escapists, ego-centrics, even psychopaths. The proponents of these theories are hostile to each other but agree that those who take more moderate views and who work with the alcoholic to help him are to be held in gentle contempt.
Needless to say, I am opposed to both extreme views. If we are to believe the physiological exponents, then many an athlete, soldier, professional man, business executive, statesman, and priest is a physical defective, when, as a matter of fact, he was as normal as you or I until he drank too much liquor.
If we are to accept the phychological point of view, then I may offer in rebuttal statistics from Knickerbocker, Charles B. Towns, and St. John’s Hospitals in New York City, which show that out of 12,000 alcoholics treated in the past five years, 80 per cent were of Irish-American descent. Will you accept the conclusion that the Irish are an inadequate, underdeveloped and psychopathic race? I may add that as an associate physician at Neurological Hospital, I dealt with many neurotics and psychopaths. None were alcoholics.
I have the greatest regard for scientific research on the subject and I am trying to do my share of it. However, the theorists, both extreme and moderate, have failed to tell us what alcoholism is or what to do about it.
My conception of alcoholism is contained in the findings I published thirteen years ago. I have confirmed them after observing some 17,000 cases under treatment. Alcoholism is a disease, essentially physical in origin, a manifestation of an allergy. This accounts for the phenomenon of the 10 per cent of the population who, if they drank, lose control over alcohol. The psychological involvement is caused by the refusal of the alcoholic to ascribe his difficulties to alcohol, and his phychic dependence on it when he has reached the compulsive state of his addiction. So much for my own diagnosis.
Whichever is correct, the fact remains -to the best of my knowledge -that no cure has yet been discovered. Not a single one. However, the disease has been arrested in nearly 100,000 alcoholics by a group that expounds no theory except absolute abstinence -Alcoholics Anonymous.
It is not so difficult to understand or recognize the early symptoms of this disease. But let me first clarify a situation that has led to a great deal of confusion. Many of the psychological descriptions of the alcoholic are characteristic marks of the constitutional psychopath.
If we accept, as many students assure us, that the alcoholic is a pathological liar, an escapist, an egocentric, and in fact a prey to all or many of the psychological terminology’s, we might just ask him why any effort at all is being made to rehabilitate him.
It is essential to understand clearly that the average alcoholic was not born with all these social maladjustment’s.
The constitutional psychopath may become an alcoholic, but he is not the type we are discussing here. It is most difficult to point out the type of man who can or will become an alcoholic.
A.A. has set forth the following yardsticks:
1) Do you notice that you drink more than others among your acquaintances?
2) Are you beginning to cheat about how much you drink?
3) Are your work and general life beginning to be neglected?
4) Do you eat less when drinking?
5) Is liquor becoming essential to carry on many of the ordinary affairs of life?
6) Are you trying to deny all this and beginning to resent advice about it?
7) Are you saying, “I can stop anytime I wish,” and prove it for a short time only?
These and numerous others are the slowly developing symptoms of disease. The phenomenon of craving will be the dominant factor, eventually to be complicated by a neurosis, compulsive in type. It is a disease so complex that, until the advent of A.A., there seemed small hope of arresting it.
In common with certain other diseases, clinically we have no cure for chronic alcoholism. Since the amalgamation of alcoholics into groups, we are able to meet many alcoholics who are completely sober for periods of from two to twenty years. But, following one drink of alcoholic beverage, the phenomenon of craving promptly returns. They cannot drink in moderation. The disease was merely arrested.
Granted that some of these people may be neurotics, self-centered, emotional individuals, are they therefore doomed to alcoholism? Such an admission would be evidence of our own inadequacy.
Let us arouse ourselves. Let us recognize the urgent need of an educational campaign. Alcoholism is incurable but it can be prevented. Let us have an educational campaign among the clergy and in the seminaries. I am not advocating the “temperance movement.” We are interested in the 10 or 15 per cent of unfortunate people who cannot drink in moderation.
Thousands of them are not the types that have been presented to us by the over zealous researchers. I believe we can escape this sorry picture by a properly integrated educational program. A.A. knows these same people: formerly violently anti-social, completely immoral, the despair of their friends and themselves; but now they are normal men and women, assuming all the responsibilities demanded by society, and even devoting a part of their lives to the assistance of others less fortunate.
However, the addiction that requires this terrific struggle back to normal can be prevented by proper and timely education. The importance and need for this cannot, I believe, be overestimated.
How important, then, how outstanding, becomes an educational program of prevention in your great body of men trained in religion. You have a problem within your own ranks, a problem which can well be met four-square by education.
I have seen literally thousands of men with all types of degrees, with all different forms of training, and from all different classes and walks of life, who are tragic victims and sufferers of alcoholism.
It is surprising, when we learn the case history of an alcoholic, to discover how little he really knew about alcohol in his youth and young manhood. This is true in case after case. It is by understanding and education, even at the eleventh hour, that hundreds and thousands of men are saved from insanity or premature death-the inevitable end of chronic or acute alcoholism.
To you men there is presented a challenge. How many thousands of parishes of yours are there in the United States? Let us picture, if you will, a young assistant in a town or city of 15,000. What a wonderful thing it would be if this young priest started a Matt Talbot group in his city. What an example he would be to many men who have lost hope, men high in the business world, and perhaps many of them learned, men who secretly think that they are the only ones who have an alcoholic problem. Invited to attend a meeting of the Matt Talbot Group, they would meet fine fellow citizens. They would be reassured, and would find that they are not standing alone. They would renew or revive the practice of prayer, particularly meditation.
Supposing in your larger cities Matt Talbot groups were organized in your Catholic parishes. Think what an army of crusaders there would be within your religion alone. You men of religion would soon be supplemented by thousands of enthusiastic members of Matt Talbot groups. This zeal would in turn be passed on by the fathers and mothers to their sons and daughters.
The young assistant priest, who was interested in social work, at times becomes discouraged; but his bishop encouraged him, and counseled him to overlook any criticism or ridicule that might come to him directly or indirectly. The young priest persisted. Today many priests are calling on him for help for their friends, their parishioners, and in some instances, for members of the clergy who have themselves become alcoholics.
The example of thousands of such priests would create a movement in this country which would not only benefit the laymen at large but would benefit the clergy as well.
In our lifetime we have seen both the Russian and the former German government train their youths so that at the age of ten or eleven they were ardent and zealous Nazis or Communists. Is it too early then, to start the young seminarian when he starts his study of theology? There is no better time to teach the pitfalls and the insidiousness of alcohol. The true knowledge of the misery and suffering of intelligent men can well be brought to the understanding of young seminarians, stressing many times that this is a major problem confronting not only the young laymen of today and tomorrow, but also the young priest of today and tomorrow.