The Treatment of Alcoholism

VTR: 3/10/1951
GUESTS: Dr. Ruth Fox, Reverend Howard Clinebell, Jr., Welin Gardner

ANNOUNCER: The Open Mind – free to examine – to question – to disagree. Our subject today, “The Treatment of Alcoholism”. Your host on the Open Mind is Richard D. Heffner., author and historian:

IMITHER: Before we• begin today’s program I’d like to thank those many viewers who have written to us here at the Open Mind over the past few weeks about our previous programs on Censorship., TV Censorship and Book Censorship. As you probably lalow„ we’re going to return to the general area of censorship in a few weeks when we talk about the question in terms of radio and television. Again, as you know, we frequently haVe serieo of programs on one subject, on censorship and now on the question of alcoholism. Several months ag0 as a matter of fact, I think it was back last summer, we did our first program on alcoholism. Then this past winter a second one, on the nature and causes of alcoholism, and today we want to talk about what we can do about alcoholism, about its treatment. I think it’s important to indicate that there are a good many people who feel that alcoholism is a moral issue, an issue involving free will. There are other people who think of alcoholism primarily in terms of it as a disease. There are many points of view. There are many different ways in which people think we can do something about this problem. My guests today have their own particular points of view and I think it’s about time that I introduced them..

HEFFNLR: First, Dr. Ruth Fox. Dr. Fox is a psychiatrist and the President of the New York City Medical Society on Alcoholism and the co-author of Random house’s book “Alcoholism, Its Scope, Cause And Treatment”, My second guest is Dr. Howard J. Clinebell, Jr, Dr. Clinebell is the Minister of the Great Neck Methodist Church, lecturer at New York University and author of the recent book, “Understanding and Counseling The Alcoholic Through Religion and Psychology”. My third guest is Mr. We in Gardner, Mr. Gardner is the Associate Director of the National Council on Alcoholism. Now I think that it might be well to begin our program on what we can do about alcoholism or about the treatment of alcoholism by, well let me ask you Mr. Gardner for a definition, a brief one.

GARUNERt: Well there are some, there are several technical definitions of alcoholism we can find but I think the best one to sum it up is that the person with alcoholism is one whose chronic use of alcohol has reached the point where it interferes with his health, his physical well-bein, his economic and vocational progreSs in life and his direct definite and the personal relations with people and his family and in the community.

HLFFNER: Is that acceptable, Dr. Fox?

FOX: I think that’s acceptable. I think it might help to point out the compulsive nature, something over which he doesn’t have much precept.

HEFFNER: Well, this compulsive nature added to the definition

(TWO VOICES) — I find it very interesting, Dr, Clinebell to note that in your new book you quoted an article by Charles 0. Hewitt in which he wrote that a Minneapolis newspaper recently printed a story about John Bones who was sentenced to the workhouse, I gather for drinking, for the 107th time. The tone of the article was one of ineffable despair at the unauthorable depravity of Dlr.

Bones who has willfully spent some 18 of the past 20 years as a guest of the city. I gather that Dr. Hewitt here meant the whimsical despair to be the key to this paragraph and I would suspect that a good many of us with despair or with whimsey, I wonder whether you think the despair is in these days being modified?

CLINEBELL: Yes, I certainly do. I believe that since the advent particularly of Alcoholics Anonymous and the National Committee on Alcoholism, the community climate of feeling and opinion toward alcoholism has been altered in the direction of hope, I would say. I mean therets a lot more hope than there was 20 years ago for an alcoholic to find help,

HEFFNER: Well now in a very general area let me fill out this question to each and every one of you, From your respective approaches of a medical person or psychiatrist, of religion, and of a lay person involved in alerting the public to this problem, what can we do about alcoholism? Now Dr, Fox suppose I ask you to begin:

FOX: Well, I think that the treatment has to be really quite many sided. I think that there are always medical problems in anyone who h4s been drinking incessantly for a long time. These have to be taken care of, I think there are always psychological disturbances. There usually have been underlying personality disturbance before one became a drinker. I think that the social factors have to be taken into complete account in treating an individual,

HEFFNER: What do you mean by social factors?

FOX: Well, the environmental situation, I think you have a much more helpful patient to choose if you have a man who is still employed and still living with his wife and children. If you had a situation where a man has been divorced and is living alone in a furnished room, this Will certainly militate somewhat against successful treatment.

HEFFNER: I see. When you talk about treatment and I notice that on our last program when I said our next program would be on the “cure” of alcoholism, Marty Maun corrected me and said °treatment”. Why emphasis on treatment and not on cure?

FOX: We know that we can never restore an alcoholic to complete, we can never get a complete cure in an alcoholic, In terms of giving him something which will allow him to drink socially again. In other words, once an alcoholic always an alcoholic. But we can teach him how to lead a reasonably happy and productive life without the use of alcohol,. This is what we would call arresting:; the situation or controllin it,

Well I think that’s generally agreed, cuuldn’t you liken it to the diabetic who has certain things, that he cannot take certain substances but in every other respect he can lead a full life. And I think one of the things that worries the alcoholic at the beginning when you approach him to try and get him to understand his problem is how am I ever going to give this thing up forever. And the point is that it has to be practically shown to him that he isn’t going to miss so much and that many people lead very full lives without the use of alcohol. It is the first thinL; that has to be shown. And it proves to be a basic clinical physical reason so far as we can tell, without proof, that alcoholics,while they can’t he restored to drinking socially, something had happened that makes them unable to take that first drink with safety. And I think if alcoholics would understand that they wouldn’t be struggling all the time to try and drink the way they once did. Alcoholics are always trying to drink like the fella next door and get back to the way he drank maybe 8 or 10 years before when he didn’t have troubles. And he wants to be like others. And he thinks that not being able – quote – “To drink like a gentlemen” unquote, is a horrible thing as far as his character
and his sense of will is concerned.

CLINKBELL: 1 would like to agree in principle with what Dr. Fox said that you put a little different emphasis, and think she’ll probably agree With this, that although it’s generally agreed by the scientists who study the problem, it is a disease of complex ideology or causes and that there are many aspects in most cases of alcoholism, that there’s a certain priority as far as treatment is concerned, That in most cases this compulsive drinking which is a symptom of something deeper you see has become a problem in Itself. A sort of runaway sympton. And it’s the first problem in most cases is to arrest the runaway symptom, In other words to help the person learn to keep from taking the first drink. Then once he’s sober the other kinds of deeper therapy to deal with the underlying problems can then have more effectiveness,

GARDNER: Then you would mean that the good practical counsellor, the good medical counsellor will face the fact the problem is in the mind of the alcoholid, HOW can I clear up this thing that my drinking has caused?

FOX: Now that’s very important, I think, If you don’t clear up the distrubance no other thing that you try to do will help the alcoholic.

GARDNER: Now I think we learned a lot from the AA on that,

FOX: Many many years of good psychiatric work and money thrown down the drain nothing is accomplished, until he stops drinking. When he finally stops drinking he can then utilize the insight psychiatry can give him.

HEFFNER: You say AA has contributed a lot —

GARDITER: That’s the first thing AA tells the new members, Right now you have one problem You have the problem of what the drinking is doing to you and the fact that you’re becoming unmanageable or it up to you to acknowledge that your life’s becoming unmanageable as a result of drinking. Don’t worry about what’s going to happen next April or what ‘s going to happen when the taxes come due or how you’re going to get out of the doghouse with your wife. Learn about the first drink, Let us help you try to avoid taking that first drink one day at a time, overcoming this idea of my goodness, S never can drink again, So concentrating on the drinking problems later the alcoholic then can get insight into other things that may need adjusting. But in the beginning, think every good therapist approaches it on that basis. The way the AA states.

CLINEBELL: It seems to me we might, can we talk about AA for a little while now? I feel as a taction this is our greatest referral resource, When an alcoholic comes to me, my first goal usually is to help him to get to AA or to help AA to get to him and make a happy adjustment. Now within this tremendously fine spiritual approach, it’s non-sectarian but it does have a vertical dimension a sort of spiritual framework along with the psychological
principles..

CLINEBELL: I have found, however, that in working with some during his difficulties excepting alcohol. And when he is on antabuse he has a chance to learn other techniques. Add during this period of lea rnirgother techniques is
when I think we bring — (TWO VOICES)

GARDNER: Well by other techniques you mean he finds he can meet these little crises in his life and handle them without alcohol.

FOX: And they don’t seem so big.

HEFFNER: That’s what brings me to the question of what then are these other areas.

GARDNER: There is one thing I would like to say to follow up, with due regard for the compulsiveness of this, I truly believe that the average alcoholic who is resisting seeking help is doing it because he fails to understand the true nature of his problems rather than the fact that he couldn’t give up the alcohol. I think that once he is oriented to the fact that there’s a physical reason, there are emotional factors but this is not over the department of self management. He can beat Jim Jones at golf, he can outsell him, he can out do anything else with Jim Jones his neighbor but he shouldn’t put his drinking capacity over there. He should put it over here with diabetes and cancer and the other health problems. And once an alcoholic has done that, and I’ve heard thousands of them say it, once I got it over here and could look at it clinically then I could treat my compulsion, my emotional problems and so forth. I just wanted to get that in. That I’ve observed.

HEFFNER: Well, I described you before inaccurately as a lay person. You’re really a minister and I wonder whether I can ask both of you gentlemen this question whether religion can play or the ministerial function, what is the ministerial function in getting the alcoholic to realize.
what —

GARDNER: Well I would just like to say that the clergyman is probably on the firing line even before the physician because the family comes to him and the alcoholic often comes to him, and right there he often has to pave that person future.

CLINEBELL: Recent studies show that its probably between 50 and 55,000 alcoholics a year go to their clergyman and the significant point is that its often, he is often the first person outside the family circle to whom the alcoholic will go. So this puts him, I feel, in a strategic place, If he is informed, if he knows how to deal and counsel with alcoholics, he can make a real contribution.
(MIXED VOICES)

FOX: Then secretly it’s not the alcoholic who goes first for treatment frequently, its the wife or the mother or the employer or family. And certainly you have to work quite a while with members of the family before you can advise them how to bring the alcoholic in to see you.

HEFFNER: Why is this, because of their resistance or the alcoholic’s?

FOX: Oh no it’s the alcoholic’s resistance to his illness. You see one of the outstanding characteristics of an alcoholic is his denial that he has an illness, And I think part of the reason for this is the word alcoholic. That, I no longer say to a person, do you think you’re an alcoholic because, I might now say do you think you have a problem with alcohol..

And the answer almost invariably is, oh yes I have a problem with alcohol but Pm not alcoholic, You see I’m not alcoholic. And then you say to him, well what do you think an alcoholic is, And really he pictures an alcoholic is the Bowery Bum, the derelict, And, of course this accounts probably for only 10% of our alcoholics in the country, The majority of the people who come for therapy are not at all – (TWO VOICES)

HEFFNER: Dr Clinebell I noticed you entitled your book, “Under standing and Counseling the Alcoholic Through Religion And Psychology,” you obviously don’t feel there’s a conflict here.

CLINEBELL: Not at all. In fact I feel that one of the aspects of the cause of alcoholism is the anxiety which is not neurotic anxiety but anxiety about death, about many many things. And religion is the answer to this kind of ultimate anxiety, as it’s been called by the psychoanalyst, So that religion is an integral part, not just as a means of getting counsel and help for the family, which is important but that the religious dimension in therapy is important too,

FOX: I think this is important not only in alcoholics because of course, most of my analytic patients are not alcoholics, And I find that the deeper you go into their problems, the more you find that many of them feel the nothings of life are never worthwhile and that they
really are searching for something sacred.

These may be people who haven’t been in a church for 20 years and still they feel a lack. And it’s part of an analyst’s problem to help people get to their church.

HEFFNER: It is helping them. I want to ask you Mr Gardner, as the Executive Director of the National Council on Alcoholism, what about the resources of the community?

GARDNER: Well I think that’s what most viewers are interested in. Where can we go, what can we do. John won’t go to AA perhaps or John doesn’t like psychiatrists. We haven’t anywhere near enough resources to meet the tremendous needs in this country but we have far far more than most people realize. Today there are over a hundred out-patient alcoholism clinics in various parts of the country. We have the new tranquilizing drugs which aid the alcoholic in the acute stage which Dr Fox can speak of better than I but as an adjunct today it eases the cut-off period tremendously. We have antabuse which has been spoken of allied with other long-term help. We have Alcoholics Anonymous, which is the big resource and I think it will be for many many years to come. We have hospitals accepting alcoholics. Many clergymen, psychiatrists and others have taken time today to learn the special approaches of dealing with an alcoholic as varying from other kinds of pastoral counseling on psychiatric or medical counseling. And when they have taken time to do that they’re very effective with alcoholics, people with alcohol.

And what werre trying to do, I think all of us here will agree that are doing anything with alcoholics is to develop a total push, a team approach to the resources of medicine, psychiatry, hospitals, the church, social work, teaching all of the vocations and disciplines, understanding enoughalmut this as it relates to their particular vocations and disciplines. And as we are getting that, we’re finding the alcoholic isn’t being shuttled from one case worker to another counsellor, getting more pushed down. Not only not helped but being pushed down through the lack of understanding. And when he gets understanding he breaks the barrier. Maybe not immediately and then when he learns something about the facts and is willing at the moment to get a,little hers

so pleased and it’s very important, as Dr Fox said I believe, that the family understands, that their attitude can make or break the recovery of the alcoholic.
(LONG PAUSE)

She is fed up into seeking help by years and months when the alcoholic’s family had sought help at many of the Alcoholism Information centers such as the one up in the Academy of Medicine in New York and others over the country. And they learn how wrong I’ve been is the new approach and the alcoholic finds then that the climate is changing in the home, –

CLINEBELL: This business of changing a community climate toward more enlightened understanding of alcoholism is a job that all the community agencies, including the church can do,

I wonder if I could say a word about preventions, it’s important. It seems to me that we must face the fact that each year we’re adding a group approximately the size of the total membership of AA, either adding or discovering about this many new alcoholics. And so at least from amy point of view, we must think more and more about prevention as well as therapy and rehabilitiation.

EFFNER: Well, what is prevention then?

LINEBELL: Well, prevention is a, various forms. One, PeoPle. don’t drink then become alcoholics. The 40 million people in our country who believe in total abstinence, of course, they aren’t exposed to the danger of becoming alcoholics. Six out of every hundred people who drink do become alcoholics. It’s a real danger.

PEFFNER: But wouldn’t you, let me just interrupt, wouldn’t you say generally that the danger is inherent not in what’s in the bottle, but in the drinker of what’s in the bottle?

LINEBELL: That’s right. But even if a sick person, if a person is very sick, if he doesn’t drink, he won’t become an alcoholic, obviously. The other thing, the general mental health approach, the sturdy personalities that don’t need a glass crutch, the glass crutch of alcoholism, and then to help remove the pressure that keeps people from having a free choice about whether to drink and how much to drink.

GARDNER: May I add what we’re trying to do in the national work and that is to alleviate the symptoms, get the facts known on a mass education basis so that people will understand when they begin to drift into it, if they do start drinking.

CLINEBELL: Very good.

HEFFNER: Would I be mistaken in saying that not only are you suggesting that this may be an answer in part for preventative medicine for alcoholism but that you are talking about mental health generally?

CLINEBELL: It’s part of the full problem yes.

HEFFNER: Thank you very very much, Dr. Fox, Dr. Clinebell, and Mr. Gardner. Next week we’re going to be turning to another very interesting subject, the title is
“The Second Sex In America”, and we’re going to be talking about the role and the place of women in American today. In the meantime, in many of your Public
Libraries you’ll find bookmarks of reading lists suggesting books to be read on the subject, we discuss here on The Open Mind. Next week on The Open Mind “The Seoond Sex In America”. See you then.

ANNOUNCER: WRCA has just presented The Open Mind. Our guests today were Dr. Ruth Fox, the Reverend Howard Clinebell, Jr., and Mr.Welin Gardner. Your host on The Open Mind is Richard D. Heffner.