Alcohol and Alcohol Problems

Alcoholism and Other Drug Problems
by James E. Royce, S.J., Ph.D., David Scratchley, Ph.D.

Alcoholism and Other Drug Problems offers a balanced and comprehensive account of the nature, causes, prevention, and treatment of the nation's number one public health problem. This edition of Royce's award-winning text, Alcohol Problems and Alcoholism, has been extensively updated throughout by Royce and his coauthor David Scratchley, with new chapters on drugs other than alcohol to reflect the most recent research in the field.

Part I, "Alcohol and Other Drugs," examines the nature and impact of alcohol as a drug and discusses historical and contemporary cultural attitudes toward drinking in America. A new chapter on the effects that other drugs can have on the user and on the family, and treatment methods, has been added to this section. Part II, "Addiction," describes the patterns and symptoms of this complicated phenomenon. The authors also use new data to illustrate the impact that addiction can have on special groups such as children, minorities, and the elderly. Part III, "Prevention and Intervention," looks at the various techniques that have succeeded or failed in curbing drug abuse. Finally, Part IV, "Treatment and Rehabilitation," surveys the range of available treatment approaches with chapters on various twelve-step programs and new information on drugs and the law.

Chapter 1

Most are aware that drugs are a major factor in our biggest social problems: violence, crime, poverty, AIDS, family disintegration " but many do not think of alcohol as a drug at all, only as a social beverage. We shall see that alcohol causes immense problems, of which alcoholism is only one. (The other drugs are dealt with in Chapters 2 and 5.)

The facts about alcohol are distorted by our emotionally charged attitudes toward drinking, drunkenness, and alcoholism. Those attitudes are the result of many factors: family situation, sociocultural experience, biological differences, prohibition, differing religious beliefs, and political, economic, and personal feelings unique to each individual. Obvious as they may seem, we must spell out some distinctions that are ignored in most arguments on the subject.

Drinking. Abstinence from alcohol is the opposite of drinking. Technically anyone who drinks alcoholic beverages, however rarely and moderately, is a drinker. About 60 percent of Americans over eighteen drink at least occasionally (down from 71 percent a dozen years ago); most are neither drunkards nor alcoholics. In fact, about 11 percent of drinkers consume 68 percent of our beverage alcohol, whereas many of those technically classed as drinkers have only a New Year's toast or the like. Less than half of American "drinkers" use alcohol more than once a month.

Drunkenness. Temperance is the opposite of drunkenness. In Chapter 3 we shall see how the prohibitionists created untold confusion by assuming that everyone who drinks is a drunkard. Actually, anybody can get drunk on a given occasion; they might not even be a drinker in the usual sense of the term. To the naïve guest at a wedding reception or the person honored at a retirement banquet, the champagne seems much like ginger ale; a subsequent arrest for driving while intoxicated is not presumptive of alcoholism. However, intoxication even by nonalcoholics is a major source of both civil and criminal problems: battered spouses and children, rape, fights, homicides, unwanted pregnancies, poor health, suicides, lawsuits, family disruptions, job loss, and a sizable share of accidents " not only traffic but also home, boat, small plane, and industrial. The degree of intoxication need not be that required to be legally drunk, as we shall see in Chapter 4, Section B.

Alcoholism. Alcoholism is the state of a person whose excessive use of alcohol creates serious life problems. An alcoholic may never get drunk, as in the Delta type (maintenance drinker) common in France and described in Chapter 6. They may not even drink, as in the case of the 2 million or so recovered alcoholics who still identify themselves as such (Chapter 8).

Alcoholics

In most minds, the word alcoholic conjures up an image of a skid-road bum. Yet only about 3 percent of alcoholics are on skid road. (Incidentally, Skid Road is the original term, named for Yesler Way in Seattle, where logs were skidded down to Yesler's mill; skid row is a later version, by analogy with Cannery Row.)

What kinds of people are alcoholics? Alcoholics may be young or old, male or female, black or white, banker or bum, genius or mentally retarded. A large body of research data has accumulated on this subject, and there have been intensive educational efforts to make these facts known to the public. Yet the old stereotypes persist and must be dealt with before any meaningful discussion of alcoholism can occur.

Skid Road? It is essential to eradicate right now the stereotype of the alcoholic as a skid-road, old, male, weak-willed, inferior derelict. If 3 percent of alcoholics are on skid road, the other 97 percent of American alcoholics have jobs, homes, and families. About 45 percent of alcoholics are in professional and managerial positions, 25 percent are white-collar workers, and 30 percent are manual laborers. Over half have attended college; only 13 percent have not finished high school. No suggestion of skid road there. Physicians, brokers, attorneys, judges, dentists, and clergymen all have a high incidence of alcohol problems.

Instead of being inferior, the average intelligence of alcoholics is slightly above that of comparable groups " for example, compared with other employees in their company. Alcoholics also appear to be superior in talent and sensitivity. Hence it is not mere emotional loyalty that prompts a spouse or foreman to assert that their alcoholic is "the finest" when not drinking. That is important, because both alcoholic and spouse tend to deny the problem by saying that the person is too intelligent to be an alcoholic.

Weak Will? Anyone with experience in the field can testify that when an alcoholic needs a drink there is no one on earth with a stronger will: They will get a drink come hell, high water, or prohibition. The notion of weak-willed moral depravity rather than a compulsive disorder stems from the days before alcoholism was accepted as a disease by the World Health Organization and important national professional associations.

Mentally Ill? The notion that a typical alcoholic is a person who drinks to escape from some inner conflict raises a complex question that is addressed in Chapters 7 and 8. Suffice it to say here that research now shows that about 80 percent of alcoholics are normal personalities who began drinking for the same reasons as anybody else: custom, sociability, relaxation, or just to feel good.

Male? The ratio of men to women alcoholics is often still reported as four or five to one. That is probably due to the double standard in our society regarding women and drunkenness. Women alcoholics are often better able to hide their drinking at home (though in the business world they may be more exposed than men) and, in any case, are not as likely to be counted by the fact-gatherers. Even when they die of alcoholism, the diagnosis is written as a total liver failure or something similar, because the doctor is a gentleman and it's not ladylike to be an alcoholic. Hence the statistics are questionable. If the truth were known, the ratio of male to female alcoholics in this country is probably fifty-fifty, an opinion shared by such national authorities as M. Block, L. Cloud, R. G. Bell, R. Fox, M. Mann, M. Nellis, and M. Chafetz. (Since English just does not have a suitable pronoun for the clumsy he/she or her/his, our use of pronouns in this book is not taken as sexist but is simply due to the inadequacy of our language.)

Old? One does not have to drink heavily for thirty or forty years in order to develop alcoholism. More than a million American teenagers have serious alcohol problems. There are full-blown alcoholics who are eight or nine years old. A visitor at open AA meetings will frequently hear, "I was an alcoholic at the time I took my first drink." Although this evidence is subjective, it is in accord with scientific findings that up to 60 percent of alcoholics are such from the onset of drinking.

Alcohol as a Drug

We reject the phrase "alcohol and drugs" because it implies that alcohol is not a drug. We insist on "alcohol and other drugs." Is alcohol really a drug? Yes, in every sense of the word. Alcohol can produce all the classic signs of addiction: changes in tolerance (the need of more alcohol to get the same effect), cellular adaptation or tissue change, and withdrawal. Chemically very similar to ether and chloroform, alcohol is a sedative, a hypnotic, a tranquilizer, a narcotic, and sometimes a hallucinogenic. For centuries it was our only anesthetic, although for practical reasons a very poor one. If it were not dangerously addictive, it would be hailed as the world's greatest tranquilizer. It is most like the barbiturates, except for three important differences:

1. Stimulant or depressant? Both. Alcohol is perhaps the only common drug that gives a lift or stimulates before acting as a sedative or depressant. Some of the latter results from the depression of inhibitory centers in the brain. But the initial effect of alcohol on tissue is to irritate or agitate or stimulate, as well as to provide quick caloric energy. Some research evidence indicates that this is more true for alcoholics than for others, perhaps right from the beginning of their drinking careers; and it is this initial stimulation that many beginning alcoholics seem to look for rather than the later sedative effect. (See Chapter 4, Section B.)

2. Selective addiction. The reason why alcohol is often not thought of as a drug is that, in contrast to other drugs, it becomes addictive to only one in ten of its users. Most people drink moderately all their lives, with perhaps an occasional drunk. Why only some drinkers become addicted to alcohol is not known for certain; we shall examine this question when we deal with causality. The fact that alcohol seems safe for most people makes it harder to accept that it is a dangerous drug for a minority of 10 million to 12 million, making alcohol by far the biggest problem drug in America. The important thing here is that people differ in their reaction to alcohol.

3. Socially acceptable. One is tempted to call alcoholism a respectable addiction. Millions of people casually invite friends in for a drink who would be horrified at hearing "Come over tonight and we'll shoot a little heroin, or drop a few barbs." Even when there is misuse, we pass it off lightly or with minor embarrassment, perhaps with the remark that everybody has a few too many once in a while. How often do we think of drunkenness as a drug overdose? Do we think alcoholic beverages should be in childproof bottles? Serving drinks is a mark of hospitality, and failure to do so smacks of puritanical repressiveness. As a result of such attitudes, even when a friend is in serious trouble with alcohol there is a tendency to minimize or excuse the behavior rather than face the issue of debilitating and even terminal illness. Society feeds the denial of the alcoholic by implying that heroin and cocaine may be dangerous, but not alcohol. Until MADD (Mothers Against Drunk Driving) influenced public opinion, manslaughter by a drinking driver was almost a socially accepted form of homicide.

Copyright © 1981, 1989 by The Free Press
Copyright © 1996 by James E. Royce and David Scratchley

About the Author

James E. Royce, S.J., Ph.D., is Professor Emeritus of Psychology and Addiction Studies at Seattle University. He is the author of Alcohol Problems and Alcoholism and coauthor of Ethics for Addiction Professionals.

David Scratchley, Ph.D., is a psychologist and addiction specialist with experience in neurosciences and pharmacology.