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Asking the Hard Questions About Alcoholism

The alcoholic came first. At least that is the answer from recent alcoholism research on the often asked chicken or egg question of which came first: the alcoholic personality or the alcoholic. In an effort to increase our understanding of alcoholism and develop more effective treatment programs alcohol researchers are studying the development of the disease among people in various age groups and through longitudinal studies that extend as long as fifty years. This is important because alcohol is a disease that changes in its severity and manifestation over time. Over time alcoholism changes the personality. The active alcoholic personality lies, evades, and dissembles however necessary to support the internal illusion that his or her drinking is not a problem. These characteristics are sociopathic in nature and in a lawyer inevitable erode professional trust.

This longitudinal research shows, among other things: first that in the main alcoholism develops slowly over a person’s life and can occur in people of all ages; second, there is no one cause, but heredity, culture, economics and the environment all contribute to its development; third, alcohol can have long-term effects on the central nervous system that can gradually change the alcoholic’s personality.

Dr. George E. Vaillant, a professor at Harvard Medical School and director of the Study of Adult Development at Harvard University Health Services has led this seminal research. Dr. Vaillant asked some very important questions in his investigation:

  • Is alcoholism an independent disease or the symptom of an underlying disorder?
  • Do certain characteristics distinguish people who eventually become alcoholics from those who do not?
  • Is alcoholism always a progressive disorder?
  • How does alcoholism treatment or participation in self-help groups, such as AA, influence the disease process?
  • Is abstinence the only reasonable treatment goal, or can alcoholics safely return to social drinking?

In his investigation, Dr. Vaillant had two unique study samples, one called the “College” sample consisting to 268 participants recruited from the sophomore classes at Harvard University between 1939 and 1944 who have been followed and interviewed every year or every other years since; and the “Core City” sample a a group of 456 men selected between 1940 and 1944 from Boston inner-city schools who were interviewed extensively before 1974 and every two years since 1974.

Based on this extended period of following the drinking patterns and alcohol related medical problems of these two groups of men, Valliant was able to reach these conclusions:

  1. Analyses of the sequence in which alcoholism and other psychiatric disorders, such as anxiety and depression, develop leads to the conclusion that psychiatric disorders, or the symptoms of psychiatric disorders, develop as a consequence of alcoholism, not the other way round. In most patients, alcoholism was clearly the first and primary disease and other psychiatric conditions were secondary. The only exception to this is that the prior existence of a sociopathic personality is a factor producing a higher risk that alcoholism will develop later.

  2. While no mental illnesses, except for sociopathy, put one at greater risk of alcoholism, other factors do, such as 1) genetics — The genetic predisposition reflected in family histories of alcoholism (particularly sons of alcoholic fathers) is well demonstrated. In the College sample 26% of the men with alcoholic relatives became alcoholics as opposed to 9% of the men who did not come have alcoholism in their families. In the Core City sample the numbers were 34% and 10 % respectively. And, 2) cultural background — The Core City sample was very useful here because it represented a variety of ethnic backgrounds, including Irish, Polish, Russian English, Italian, French Canadian, Anglo Canadian and other Northern and Southern Europeans. Strikingly alcoholism was five times less common in men of Italian and other Southern European descent as compared with Irish and other Northern European groups.

  3. Early studies had suggested that childhood environment might also be a factor distinguishing people most likely to become alcoholics. The Core City sample at first appeared to confirm the hypothesis that warm and cohesive environments and close relationships were most characteristic of the men who did not become alcoholics, but further analysis showed that these differences generally could be accounted for by the presence or absence of a biological alcoholic parent. Men with few childhood environmental weaknesses but an alcoholic parent were four times more likely to become alcoholic than men with many childhood environmental weaknesses. If alcoholism in biological parents is controlled, a troubled childhood environment does not per se appear to affect a person’s risk for alcoholism.

  4. Alcoholism appears to be progressive, but there is great variety in the patterns of this progression. Some people developed alcoholism after a few months of abusive drinking. Others drink heavily for years before becoming alcoholic. And for still other alcoholics the condition may remain for years at a chronic but relatively stable level without getting better or worse.

  5. AA appears to be at least as effective as clinic treatment in helping alcoholics to begin stable abstinence. Moreover it is much more important than treatment in being able to help assure long term stable recovery. Like treatment for other chronic diseases, ongoing treatment is necessary and AA provides daily or weekly help for years.

  6. There has always been a debate among researchers as to whether or not efforts in treatment to promote moderate or controlled drinking for alcoholics are either appropriate or possible. AA and many medical and mental health professionals favor abstinence as the only solution; they believe that loss of control is inevitable once an alcoholic starts to drink. Advocates of controlled striking are often behavioral or cognitive therapist who see alcohol dependence not as a disease to be cured but as a habit that can be modified by changing the circumstances that maintain it. Interestingly Dr. Valliant’s study found out why this debate should be so clouded. The longitudinal results show that a short mid-term return to controlled drinking is possible for many alcoholics, but that a long-term return to controlled drinking is rare and an unstable outcome. Thus, though a return to controlled drinking for some alcoholics who are in early stages of alcoholic abuse is possible with the aid of certain therapeutic techniques, stable outcomes for these alcoholics are short lived. In the long haul, both the Core City and College samples demonstrate that abstinence is the most effective treatment goal and the only stable one.

– by Don Carroll

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