Alcoholism

Alcoholism is the third largest health problem in our country today. It is estimated that 10 percent of all drinkers in America will become alcoholic. I am concerned that, due to the increasingly stressful situations continually occurring in the Golden Triangle, as well as the United States, people in our area will be prone to fall victim to the disease of alcoholism, or other chemical addictions. Alcohol is one common mode of coping with psychological distress.

In the past, while at MHMR, I worked with a great many alcoholics. Probably around 25% of my caseload was alcoholics or the relatives of alcoholics. In general, they are highly intelligent, sensitive people with strong needs for achievement. However, somewhere along the way, they developed inadequate or pathological defense mechanisms for coping with stress. They turned to alcohol to supplement their insufficient coping skills.

It is my belief that the emotional development of the alcoholic is often fixated or arrested at the age when they first began drinking pathologically, even if that is in their early adolescence. This is because the use of alcohol prevented them from experiencing and working through the usual developmental stages associated with emerging adulthood. For many alcoholics, this fixation appears to have been at an adolescent level. Thus, they tend to be impulsive, angry individuals with a low frustration tolerance and poor long-range planning abilities, similar to adolescents.

Another characteristic of alcoholics is their strong dependency needs. They seem, more than “normal” individuals, to need someone or something from outside themselves to “fill them up”, to make them feel that they are worthwhile people. They tend to be very oral-oriented people. If you ever attend an AA meeting, count the number of people who do not smoke cigarettes or drink coffee. Their number is very few.

A practicing alcoholic invariably is experiencing a conflict between his/her values and his/her behaviors. I have heard alcoholics describe themselves as werewolves, turning, with alcohol use, from nice, decent individuals into self-centered, cruel people who behave in an antisocial manner. However, even when they are acting in destructive ways, their values remain the same as before. Thus, they end up despising themselves, which gives them one more reason to drink, and perpetuates the vicious cycle.

Two sorts of people do not seem prone to becoming alcoholics, no matter how much they drink. Type B individuals who are very laid back and who tolerate frustration well seem to have few problems with alcoholism. Also, psychopathic individuals who do not have the capacity to experience guilt and who have few values to be in conflict with their behavior seldom become alcoholics.

The prognosis for treating an alcoholic depends upon several factors. I prefer to work with alcoholics who have “hit bottom”, i.e., who have lost or are on the very edge of losing their jobs and their families. At this stage, their denial of having a problem and their ability to project or blame other people for their failures is minimal.

Alcoholics need to be able to be honest with themselves. I cannot emphasize enough how important this is, nor how difficult for the alcoholic to accomplish. Their ability to con themselves as well as others is superlative. Even after several years of working with alcoholics, I still get sucked in occasionally, because their stories sound so plausible and sincere. I think that is one reason AA works so well. It is much more difficult for one alcoholic to con another.

I am a strong believer in Alcoholics Anonymous, or AA. It works, for a multitude of reasons. AA gives the alcoholic a structured set of principles, called the Twelve Steps, by which to live. The general philosophy espoused by AA is a good one for anyone to live by, alcoholic or no. AA also provides frequent non-alcoholic occasions to attend social gatherings. I think many alcoholics who are used to going out and partying on the weekends switch to attending meetings on weekends, partially for the social factors. Finally, probably most importantly, the strong spiritual aspect of the program fulfills an important need that the alcoholic, indeed, for all of us, experience (and that is as close as I’ll ever get to preaching religion to my readers).

I always like to recommend a couple of books for readers who are interested in pursuing the subjects in my papers in more depth. I’ll Quit Tomorrow, by Vernon Johnson, is a classic manual for use by interested relatives who are wondering how to get their alcoholic family member into treatment. The Big Book, Alcoholics Anonymous, is the basic text for AA. I do not think that any alcoholic or relative of any alcoholic can honestly read the Big Book without identifying with the events and feelings described therein. Some individuals may be turned off by the strong spiritual element of the book, however.