Alcoholism

THE OPEN MIND
Host: Richard D. Heffner
Guest: Dr. Nathan Kline
Title: “Alcoholism”
VTR: 12/31/82

I’m Richard Heffner, your host on THE OPEN MIND. And I should note that today’s program is a rather special one. One aimed at us all, but with an eye to that old variation on a familiar theme, “What are we going to do tonight?” That’s literally the case, for you’re watching this particular OPEN MIND just before the biggest bash in our whole calendar year, New Year’s Eve. And what seems like an eminently appropriate moment to discuss an enormous problem so many of us Americans share in one way or another: Alcoholism. It’s really time to think through a bit more than we usually do what we ought to be doing tonight and every night, in sober recognition of a recent Gallup Poll’s grim statistic that actually a third of Americans have a drinking problem in their families. There are nine to ten million problem drinkers over the age of 18 in America, about six percent of our entire adult population. Now, these figures are horrendous, and rising. And I’ve asked Dr. Nathan Kline, one of this nation’s most distinguished psychiatrists, and a world-renowned expert on psychopharmacology, to talk with me a bit about what to do tonight, and in all of our tomorrows.

Dr. Kline, thanks for joining me today on THE OPEN MIND. And we’ve known each other for a long time, and I know that you’re a philosopher as well as a psychiatrist. And I wonder why we are faced with this problem of alcoholism today. What can one say about the way we live and what we do and what we don’t do that would explain it?

KLINE: Well, I think it’s not a simple answer. That is, there’s not just one cause for what you call alcoholism. And I’d, first of all, like to make a clear distinction between drinking and alcoholism.

HEFFNER: You mean tonight we can drink without considering ourselves to be an alcoholic?

KLINE: I would hope so.

HEFFNER: Okay.

KLINE: I think even the Bible advocates the joys of drinking. The problem is that in certain individuals they become excessive. Normally, alcohol is pretty much misunderstood as to its function. A lot of people think that it is actually a depressant or that it serves to exhilarate a person. Actually, alcohol is what might be called a disinhibitor. It removes a lot of one’s inhibitions. And the same, incidentally, is true of things like sleeping medications, so-called minor tranquilizers. These don’t actually, necessarily, put people to sleep. You can give someone a fixed amount of alcohol, put them in a quiet room, don’t disturb them; they’ll probably go to sleep. You can take the same amount of alcohol, give it to someone, put them in a party, and they’ll behave much more uninhibitedly than they would if they hadn’t had the alcohol. And the reason we use alcohol so frequently – cocktail parties, or drinks before dinner – is that it serves as a disinhibitor. It loosens people up a bit and helps us relax from the generally uptight kind of existence that most of us have to lead.

HEFFNER: Why then or how then can you explain the fact that the numbers of people who have problems with alcohol seem to be increasing?

KLINE: Well, there’s dispute, and what I say is of my own reading of the literature. And I wouldn’t want it to be taken as the final word, because if we had the final word, we’d probably have the final answer to it, too. We don’t. There is evidence that in certain individuals that they are acutely uncomfortable metabolically. And there have been a variety of studies – none of which have been entirely consistent – showing certain chemical factors are different in, perhaps, a third of people who become chronic alcoholics. The most recent is one that I happen to have read only last night. An article which would indicate that endorphins – which is a product of the brain’s hypothalamic nuclei, which is apparently necessary to stimulate the pleasure center in the brain – in certain individuals is deficient. And this is probably also the cause of depression, or one of them. And in individuals who drink what we could consider to excess, it does seem to cause the release of endorphins, so that these people are then able to get a certain amount of pleasure which they don’t get, not only sober, but even when they take what for most of us would be a quite adequate does of alcohol.

HEFFNER: You mean that even excess drinking is a search for pleasure, rather than, in some peculiar way, a search for pain?

KLINE: I have difficulty with the belief that one searches for pain, well, unless one says that pain gives one pleasure.

HEFFNER: All right. Fair enough.

KLINE: No, it’s not fair enough. I mean, that’s a secondary effect of individuals who, for one or another reason, are conditioned so that things that ordinarily would be considered painful are, in the long run, in a perverse kind of way, give more pleasure than they do pain. So that basically I think that most of us are pleasure seekers, or avoiders of pain. I don’t think that we would have survived as a species if we’d worked in the opposite direction.

HEFFNER: Well, Dr. Kline, okay. Tonight we are all going to be seeking, or many of us will be seeking pleasure. And drink, as you say, ion moderation, will be part of that search. Why will some of us find this, part and parcel, an ongoing process to which there seems to be no end and there seems to be no rational basis, there seems to be no reason in terms of the natural course of one’s life?

KLINE: No. Well, I’m offering an explanation for roughly a third of people, that there may be some kind of a biochemical deficiency or excess or aberration that is somehow or other corrected by alcohol. Or these individuals can also be extremely sensitive to alcohol, and doses that would satisfy most of us will be too much for individuals of that type. There is evidence that in about a third of people – it’s not of the sort that’s fully acceptable as yet, but there are repeated studies that keep indicating that perhaps a third of people who do become chronic alcoholics do have some kind of a metabolic deficiency of one kind or another.

HEFFNER: That’s a positive finding, isn’t it? I mean, it’s one that should lead us to feel positively. If you find a deficiency…

KLINE: Correct.

HEFFNER: …presumably, you can make up for that deficiency.

KLINE: Eventually. Right. The difficulty is that the findings have not been entirely consistent. It’s difficult to identify who these people are. And we’re still probably back in the age of alchemy as far as psychopharmacology is concerned. That is, we can treat certain disorders; but medicine always works backwards.

HEFFNER: What do you mean?

KLINE: Well, you usually find a cure for something or the treatment for something, and then you begin finding out how the treatment works, and eventually you find out what the cause of it is. We, today, for instance, have very effective treatment for most types of depression. And that is in psychopharmacology. This medication that will, in 70-80 percent of patients, at least, sometimes even higher, cause relief of depression. But we don’t know what causes it. We have theories, but Lucipus, some 2,000 years ago, said that, “Where there is ignorance, theories abound”. If we know the explanation, we wouldn’t have a lot of theories. And so the same probably true with alcoholism. There has been a theory that alcoholism is a substitute for certain types of depression. This, again, has been disputed more recently. And there is, by and large, evidence that people drink more when they’re manic, that is when they’re feeling very good, than when they’re feeling very bad. One recent study showed that people actually drank less when they were depressed than they did under ordinary circumstances; although, again, we have the opposite point of view: since depression is twice as common in women as it is in men, one of the theories has been that, since alcoholism is much higher in men than it is in women, that this is a substitute for depression. By and large, alcohol is a lousy treatment for depression. It will explain, however, another question about tonight, which is why, probably, another proportion of people drink. I think New Years is, by and large, despite its reputed time of gaiety and good times, is probably one of the most desperately dangerous of all the holidays.

HEFFNER: Dangerous?

KLINE: Sure. It’s the time of the year when you look back and look what all the things you haven’t accomplished during the year, of all the people who were there last year and aren’t there this year. This year, in particular, with the economy the way it is, there are going to be a lot of people who had jobs at the beginning of the year who don’t have them now, or who are concerned about whether they’ll keep what they have. So, in some ways, it’s a very desperate kind of a holiday. And alcohol, in that sense, is sometimes used so you can drink to extinction rather than distinction.

HEFFNER: You’ve depressed me, which I hope doesn’t lead to excess this New Year’s Eve. But what about…let me ask you about the other two-thirds. You said you believe that studies have sufficiently identified one-third of the…

KLINE: Well, studies are at the point where I would, as a researcher, feel that there probably are, although I would have difficulty in proving it, either in a court of law or in a scientific journal. But here are enough papers that have accumulated with enough evidence in general that probably about a third of people who become chronic alcoholics do so because of some kind of a biochemical eccentricity.

HEFFNER: And the other two thirds?

KLINE: I think another one-third do it for social, out of custom.

HEFFNER: You mean they become alcoholics because they begin to drink socially?

KLINE: Right. Then they have a need for it. One of the classical definitions is the individual who, first of all, reaches a point where he can’t do anything unless he has a drink. He can’t perform, even thought I may be mechanical work, or intellectual work. He has to have a drink. And then it finally moves on to the point where he has to have the drink, and then he can’t do it. I mean, that’s really the pit, and you’re in very serious trouble. But I think a lot of drinking is done for social reasons. It varies from country to country as you, I’m sure, are well aware. And interestingly, in countries, places I’ve spent a reasonable amount of time, like Iran, Persia, where alcohol is forbidden under the Koran, under Mohammedan law, it is in places like that that people frequently turn to opium or marijuana. In Iran, opium is very widely used. Not as it is here, so much in the form of heroin, but it’s usually smoked or eaten rather than mainlined or taken in the form of heroin. So it would appear within most cultures their people become very intolerant of their own sweaty selves and want some relief from it. And, dependent on the culture, one way of doing it is to be a hale fellow, well met, and drink.

HEFFNER: And that you would categorize or pigeonhole-ize as a social approach? This is drinking or smoking or whatever for social purposes? That’s a trap, isn’t it? That people find it very hard to be aware of the fact that they are moving slowly and perhaps inexorably out of the social drinking phase?

KLINE: It takes real courage or guts or stamina or character, whatever you want to call it, not to drink when everybody else is tossing them off as fast as they can, because you’re urged on all sides to drink. And it takes real character to say “I’ve had enough”, or, “I’m still working on this one”.

HEFFNER: Well, that’s tonight or any other night. But I suspect it must take more to be aware of the fact that you can bet booby-trapped into this routine, and that social drinking, “I just drink with the guys, or drink with the girls, or drink with both, to be sociable”, can lead very, very quickly to something more.

KLINE: Right. I think it’s not too difficult to learn what your own capacity really is. And then simply to limit yourself to one more than that.

HEFFNER: What are the signs that you are reaching that level?

KLINE: The major one is that you don’t remember what happened the night before.

HEFFNER: Well, wait a minute. You’re talking about getting drunk.

KLINE: Yeah.

HEFFNER: But am I incorrect in assuming that social drinking catches up with you at times without having gotten drunk but becoming, step by step, dependent upon the damned stuff?

KLINE: Yeah. There are people who do that sporadically rather than steady drinkers. There we’re back to social customs. I mean, in France, for instance, people drink more or less continuously. The volume is usually low, although the French have as many alcoholics, at least, as we do, and they all worry about their livers because the alcohol is supposed to affect the liver. In this country, people tend much more toward, in general, towards spree drinking, and that’s a more typical pattern.

HEFFNER: You have had…Go ahead. I’m sorry.

KLINE: I was going to say, another way of looking at the evidence for it is a study we did five or six years ago in one of the Veterans’ Administration hospitals. And I would add, by the way, that the major problem of all the VA hospitals in this country is alcoholism. And it’s plain and simple. We did a study using Lithium to determine whether it would have any effect on drinking habits. And it turned out to be quite effective. It was repeated by the Medical Research Council in England, and there was a lead article in Lanset about five, six years ago. But just as there is a prejudice…Well, there is a certain amount of prejudice against using any kind of medication in general, and particularly for members of AA who feel that any kind of drugs at all are contraindicated. And for many people it may well be the case. But for, again, for certain types of alcoholism this appeared quite effective in either eliminating or markedly reducing the amount of spree drinking.

HEFFNER: You had said you divided alcoholism into thirds. And one-third, perhaps a response to a chemical imbalance. One-third, you were starting to say, social drinking. Again it’s the pattern. What about the other third?

KLINE: The other third, which is the part of what you left out of your introduction, that you talked about people over the age of 18. I think by far the most serious problem is drinking in people under 18, because in that group, as in a third of the adults, alcoholism is used to “solve” (in quotation marks, since it doesn’t solve) personal problems. It’s a way of avoiding facing an unpleasant reality. And it give you, by disinhibiting the individual, it allows them not to think about whatever it is he ought to be thinking about. And if you remain more or less continuously under the influence of alcohol or every time you have a problem, instead of dealing with it, you go out and you belt down a few drinks, you never do face the problems. And you never really do grow up.

HEFFNER: You’re touching upon a subject that in our catchment area here is becoming more and more important because of the effort on the part of legislatures to limit the drinking age. What’s your own feeling about lowering the age at which drinks can be served to youngsters?

KLINE: You mean raising it?

HEFFNER: Or raising it. Excuse me. The kids are fighting for lowering; we’re fighting for raising, some of us. What’s your own feeling about that?

KLINE: I don’t think that is…I think it may have some effect, but I don’t think it’s getting at the core of the problem. But the argument, of course, on the other side, which is easily summarized: I’m old enough to be sent off to war and get killed at the age of 18, but I’m not old enough to order a drink.

HEFFNER: To which the answer is: No one should be killed, or ordered to go off and get killed. Let’s put an end to that one right there.

KLINE: Okay.

HEFFNER: But what’s your own feeling about the prohibitions?

KLINE: Yeah. I really think that what’s much more important is one, to try to identify those individuals who have some kind of a biochemical peculiarity so that they won’t have to drink. I mean, out of, really, necessity, if you will, or in order to feel half normal. I think the social customs can be modified. If you look back at the relatively short history of civilization, six or eight thousand years, we’ve made a fair amount of progress in a few areas. Slavery, at least, in its most overt form, is no longer acceptable. Starvation is generally not accepted. I mean, we do something about it. And I think it’s a matter of understanding what’s involved with excessive drinking, and educating people. And that would take care of two-thirds. The final third is that whatever it is that brings about the kind of personal, intrapersonal problems, or interpersonal problems that tend up in drinking, that again, I think, if we understood more about motivations and behavior that we would be able to either, hopefully, prevent situations of that sort developing, or at least catching them early or doing something about them. And that’s why when street drugs become scarce, as they do from time to time, then there’s more tendency for the under-18 group to turn to alcohol and in some ways it’s a much more vicious drug than almost any of the others. Largely because it does have acceptable uses in society. And the borderline between what’s acceptable and what’s no acceptable is pretty hard to define.

HEFFNER: Dr. Kline, is there any indication that patterns of drinking are set in families, that the kids follow what the parents do; or do they reject what the parents do?

KLINE: Very often they do follow in familial patterns. And if they see an adult in the family who manages to drink and come home and generally raise havoc and beat up a few other family members that are under stress, as we all get under when they become a bit older, they have had a role model which says this is acceptable behavior. And so that…And the converse is true. I mean, in certain social groups and subgroups, getting drunk is very much frowned upon. And, as you know, there are probably about 15 percent, I think was the figure, of Americans who don’t drink at all.

HEFFNER: You know, we were speaking before about that one-third, and of the one-third that you believe there is some chemical imbalance. Is there any distinction, as the research indicated, any difference between the kinds of drunken states experienced by those who are, in your estimation, biochemically imbalanced, and the others? Tougher, rougher drunks? Not so? No distinction?

KLINE: Not that I know of. I think that part of that subgroup are people who are overly sensitive and tend to pass out rather quickly on very little alcohol.

HEFFNER: So they can’t be that troublesome?

KLINE: No. They’re not the ones who go home and beat anyone up.

HEFFNER: Right.

KLINE: And then again, there are traditional…Alcohol is far from simple, as I need not tell you, because purportedly if a young lady has too much to drink, then her – not that it’s a problem today but when you and I were young, Richard –

HEFFNER: I can’t remember back that far.

KLINE: I think it was Dorothy Parker who said, “Candy is dandy, but liquor is quicker”. That it allowed one, by disinhibiting the individual, to indulge in behavior that other wise wouldn’t take place. That still happens. I mean, there are still certain kinds of social behavior which is unacceptable but if you’ve had enough to drink, whether in actuality or it’s an excuse, then you can say, “Well, it really wasn’t my fault. I was drunk”.

HEFFNER: It seems to me that what you’ve said here today has to be a source of optimism in the sense that if one can begin to identify that third of this population of alcoholics who have this biochemical imbalance, then I presume that as in your other studies, as in other areas of concern, you can begin to compensate…

KLINE: That’s a source of discouragement, too.

HEFFNER: Why?

KLINE: Well, the budget of the National Institute for Alcohol and Alcohol Abuse or Substance abuse, budgets are being cut. The mount of money spent on research for problems of this sort is miniscule compared with an MX missiles. They should spend more for mixtures instead of MXes, because these are much more important problems. But in the Soviet Union, by the way, the incidence of alcoholism is even higher than it is here, so that instead of competing against each other in areas of that sort, it would be very pleasant to collaborate in trying to solve what seems to me a problem that is much more dangerous than – I’ll probably be disagreed with – but much more dangerous than the nuclear problem is.

HEFFNER: Are other nations investing more in an effort to deal with alcoholism?

KLINE: No. Unfortunately, the United States, in that area, has been the great role model, led by, interestingly, not physicians but lay people like Murray Lasker and others who have seen the importance of medical research and convinced the, led to the formation of the National Institutes of Health, which has been a model for other countries.

HEFFNER: Is there any indication – and we just have a couple of minutes left – Is there any indication that in our schools we’re beginning to teach something about drinking and not drinking? Something about the dangers of alcoholism?

KLINE: We don’t know enough about it, Richard, to really teach anything that is really meaningful as yet. We’re at a point where it is foolish to try to exert controls when we don’t know how to exert the controls. We have no way of detecting. We can detect underground nuclear explosions or ones in the upper atmosphere; we can’t detect the individual who’s going to be a potential alcoholic. And it seems to me that that’s what civilization ought to be doing instead of some of the foolish things that it does.

HEFFNER: I don’t know whether then we should sum up and say, “For crying out loud, the problem is so bad, go out and belt a few”.

KLINE: No.

HEFFNER: What’s your advice?

KLINE: I think we ought to go out and have a drink. And we ought to drink to the fact that in six or eight thousand years we’ve made a little progress, and hope that in the next six or eight thousand we’re going to make a little more. But I think we ought to have the drink.

HEFFNER: Nathan Kline, thank you again for joining me on THE OPEN MIND. You are always sure to end on an optimistic note.

And thanks, too, to you in the audience. I hope that you will join us again on THE OPEN MIND. Meanwhile, as an old friend used to say, “Good night, and good luck”, and Happy New Year!

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