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February 1956

PSYCHIATRIC AND MEDICAL VIEWS

1955 News Round - Public enlightenment action are trends in the year's news about alcoholism

A Grapevine Milestone Report Based on Research and Interviews

PUBLIC acceptance of the concept that the alcoholic is a sick person, can be helped and is worth helping showed accelerating progress in 1955.

This all-important trend among the general public toward the clinic-tested reasoning of doctors and the AA-tested experience of recovered alcoholics stands high among 1955 developments vital in the lives of millions to whom drinking is Problem Number One. The latest available estimate on the number of such people is 4-1/2 million, of which 700,000 are women, according to the Yale University Center of Alcohol Studies.

Other highlights of the year were the significant emergence of Alcoholics Anonymous from its teens, and the inclusion of alcoholism as a prominent phase of a three-year survey of mental illness problems authorized by Congress. The year also saw, among medical circles, a qualified acceptance of some tranquilizing drugs as an interim aid in steps to sobriety.

DEVELOPMENTS IN AA

Although AA keeps no official membership records, a steady increase in the number of groups voluntarily registered at AA General Service Headquarters in New York is reported, the total at the end of 1955 being 6,482 groups. New groups registered during the year numbered 555, and the total membership reflected in the limited and minimal estimates from all groups at the end of 1955 stood at about 140,000. AA is now represented in a total of 71 countries.

The most significant event within AA during 1955 was the "coming-of-age" Convention in St. Louis last July, when AAs by the thousands voted to assume full responsibility for the society's affairs, through an annual General Service Conference of elected delegates. The same month also saw publication of the second edition of the Big Book, Alcoholics Anonymous, with its original text unchanged but with 110,000 more words of new material, principally new case histories. A third trend of some note was the development to general public interest in the Alcoholics Anonymous program of recovery from alcoholism, to the extent that several non-AA-originated books and articles, movies, and television features dealing with AA received wide attention.

GROWTH OF FAMILY GROUPS

An organization closely related to AA but entirely separate from it, the A1-Anon Family Groups, began a dramatic acceleration in growth during 1955. Some 200 new groups were formed, bringing the total to 800. The organization also published a book in 1955: The Al-Anon Family Groups: A Guide for the Families of Problem Drinkers, and was also the subject of articles in two national magazines and several radio and television programs.

OTHERS CONCERNED WITH ALCOHOLISM

Elsewhere, many non-AA agencies interested in alcoholism reported continued expansion of activity. The National Committee on Alcoholism urged that those around the alcoholic, professionally or otherwise, develop a better understanding of the dynamic physical, emotional and spiritual changes necessary for recovery. Professionals were reminded that many sufferers receive their counsel, often for a long period, before coming to accept the help of Alcoholics Anonymous.

Those in official or quasi-official authority were asked to help break the "climate of stigma and shame" which has surrounded the alcoholic. The committee, dedicated to "prevention of alcoholism--through education, rehabilitation and community services," pleaded with doctors to learn the explicit medical treatments which have proved successful and to avoid methods which might produce an addiction even worse than the alcoholism. The latter reference was to the barbiturates and other drugs which have posed the threat of addiction and death to some.

Ministers, often sought out before any other resource, were called upon to understand alcoholism as a disease and to learn how to gain a rapport with the supplicant. Hospitals were solicited to be willing and able to provide treatment for the acute phase of the disease.

All were cautioned that if they find the alcoholic repugnant, indicate even tacitly a feeling of hopelessness, and are unaware of local resources such as AA, they may well increase the despair and defeat of the victim who approaches them in tentative surrender.

PROGRESS IN MANY FIELDS

The targets of the Committee's entreaties were entitled to great praise, nevertheless, for their progress in 1955:

Ninety-seven outpatient clinics, most of them maintaining good working relationship with local AA groups, are now operating in this country with state or private sponsorship.

An estimated 3,000 hospitals in the United States now accept alcoholics per se as valid patients, in contrast to only 97 hospitals in 1946.

An American Medical Association bill in Congress, to stimulate treatment and research into alcoholism under Federal grant, appears likely to dodge the guillotine next year.

Many conferences on alcoholism helped in 1955 to orient the clergy of all denominations, with emphasis on the pastoral counseling of alcoholics. Particularly important was the annual four-day North Conway (N.H.) Foundation conference on alcoholism, attended by ministers of all faiths.

The National States' Conference on Alcoholism and the National Committee on Alcoholism, with grants from the United States Public Health Service, brought doctors and clinic directors together in scientific discussion of alcoholism. The National Conference of Social Work, the American Orthopsychiatric Association and other health and welfare groups dealt, at their 1955 annual meetings, with the subject of problem drinking.

Alcoholism (as "a nation-wide problem in which mental illness is frequently a component") is an important phase of a $1,250,000, three-year survey of mental illness problems authorized by the Eighty-fourth Congress. Non-governmental agencies will conduct the study.

The National Institute of Mental Health has earmarked $86,000 for a three-year study of chronic alcoholism, to be carried out at the Massachusetts General Hospital in Boston.

Twenty-seven states now have state alcoholism programs. There were none ten years ago. Three Canadian provinces now operate treatment and rehabilitation facilities.

Community action programs stimulated by the National Committee on Alcoholism, fifty-two of them with public information centers, are operating in fifty-six major United States municipalities.

A score of programs dealing with recovery from alcoholism were presented by major radio and television networks. Some veteran Twelfth-Steppers, watching a low-bottom sufferer reaching for the phone to call AA in one video play, almost expected to receive the call in their homes.

AMA SPOTLIGHTS ALCOHOLISM

The American Medical Association's committee on alcoholism has:

Recommended that alcoholic patients be accepted by general hospitals and receive treatment as patients suffering from a disease.

Urged a study of ways whereby medical service insurance companies, such as the Blue Cross and Blue Shield, and private companies within each state could accept and treat alcoholism as a disease, giving full coverage under present policies as is now done for a variety of other diseases.

Encouraged use of the terms "successfully arrested" or "recovered" rather than "cured" in cases of addictive drinking, the criterion for these terms to be several years of continued abstinence.

Drafted a booklet on modern treatment to help general physicians administer to alcoholic patients.

Considered the advisability of making alcoholism a reportable disease.

INTERNATIONAL EXPERTS EMPHASIZE RECOVERY

International concern with problem drinking is reflected in a four-page newsletter issued by the United Nations' World Health Organization. Published in English, French, Spanish and Portuguese, much of the supplement is a discussion of "AA-Help Without Conditions" authored by a member of the Oslo AA group. The UN organ points out that "although certain people are more likely to become alcoholics, given certain conditions of stress--social, financial or both--there is no such thing as a personality which dooms an individual to alcoholism.

"Further," it promises, "there is no stage, not even in the final phase of alcohol domination, at which rescue is impossible."

The United Nations, in a 1955 report by an international group of experts, warns that in many countries the concern of public authorities with the problems of alcohol still does not go beyond some regulation of the sale of alcoholic beverages, the punishment of drunkenness and the care of alcoholics with psychoses only.

The experts reason, however, that "if public health authorities can be shown that alcoholism as a behavior is per se a medical disorder and that social-economic factors are contributing elements to its study, public health workers will not shy away from it, since social and economic elements are involved in most of all health problems with which they have to cope."

The report recognizes three facts familiar to AAs:

In all alcoholics there is a release of the primitive side of the personality--the pathological desire for alcohol becomes more evident as the inhibiting forces weaken and ultimately fail.

In a small group of drinkers the pathological desire for alcohol appears practically at the beginning of their drinking, instead of after many years, and can thus lead to a rapid development of alcoholism.

Among those who obviously face a serious alcoholic problem are week-end drinkers who consider three or more days a "normal" week-end.

YALE CENTER REPORTS

The Yale University Center of Alcohol Studies has just put into worldwide circulation an almost complete bibliography of scientific literature on alcohol problems. "The Archives of Alcohol Literature," representing twenty years of effort, are compiled on I.B.M. cards and entrusted to twenty-nine, depositories throughout the world, seven of them in the United States. The collection is considered the largest of its nature ever assembled.

An attempt to provide unbiased, scientific facts concerning alcohol and its use for the instruction of students in secondary schools, junior colleges and community youth groups is embodied in teaching material prepared by the Yale Center during the past year. Yale Center projects in 1955 also included a study of hangover (its causes, effects, etc.), and a report on the drinking patterns of American Jews and the use of alcoholic beverages by Americans of Italian descent and by Italians still residing in Italy.

Active members of AA comprised one-fifth of the student body at the 13th annual session of the Yale Summer School of Alcohol Studies. Educators, clergymen, physicians, case workers and psychologists joined in the systematic investigation of functions and problems of alcohol as they affect the individual and society. The 1956 session will be held July 1-26.

PSYCHIATRIC AND MEDICAL VIEWS

On the psychiatric front considerable progress was noted in the breadth and depth of interest in the mental and emotional aspects of alcoholism. Attitudes toward the most effective method of treatment ranged all the way from unqualified endorsement of AA to some continuing ignorance of successful recovery via AA. A typical middle attitude seemed to be represented in a statement by Dr. Curtis T. Prout, assistant medical director of New York Hospital, Westchester Division, who said that in his opinion AA is one of the seven most effective approaches to the treatment of chronic alcoholism. He listed the other six as: long-term hospitalization; outpatient clinics with psychotherapy and adjuvant therapy; psychotherapy, including psychoanalysis, interview and group therapy; conditioned reflex therapy; endocrine therapy; and disulfiram (antabuse). Dr. Prout added:

"Why the alcoholic turns to alcohol instead of some other form of escape when under tension, why he cannot stop after one or two drinks, or why he is continually trying to prove to himself he can drink again, knowing the consequences, are questions remaining to be answered. The very fact that there are so many methods of treatment indicates that there is no specific and the best therapy comes through teamwork."

Medicine in its search for specifics found during the past year that certain of the so-called tranquilizing drugs have been useful in the treatment of acute alcoholism, under medical supervision, but there was no claim that the new drugs will assure physical or mental sobriety, or serve as a substitute for AA therapy. They will, however, reduce the usual symptoms of withdrawal following a cessation of prolonged drinking, according to doctors working with the drugs. In this connection, individual AAs have reported personal knowledge of alcoholics requiring hospitalization for addiction to so-called "non-addictive" tranquilizing drugs.

Dr. John A. Lewis of the National Institute of Mental Health, U.S. Public Health Service, said that tranquilizing medicine will facilitate a new program to promote the treatment of acute alcoholism in general hospitals, initiated by the Alcoholism Committee of the American Medical Association.

The Federal government has within the past year distributed innumerable "do-it-yourself" pamphlets dealing with hobbies, household repairs and self-improvement. None deals with sobriety.

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