Customer Reviews

Under the Influence: A Guide to the Myths and Realities of Alcoholism

5 star:		(32)
4 star:		(5)
3 star:		(7)
2 star:		(2)
1 star:		(1)

 

 

I find the comments that the book is out of date sad, because the vast majority of alcoholism treatment programs as well as public opinion have not yet caught up to this book.

Milam advances several important concepts:

1. Alcoholism is a disease like diabetes. Psychology and morality play no role, except in the alcoholic's reaction emotionally to the consequences of the disease [hiding it, seeking help, etc.] If you think this view of alcoholism is completely accepted now, try telling your boss you are an alcoholic.

2. Milam then explains HOW alcoholism is a disease in fascinating detail. Alcoholics are not addicted to alcohol, but to a complex physical process that happens when they drink. Basically, the alcoholic's body reacts to the presence of alcohol in the body differently from that of a "normal" person, and no amount of counseling/threats/religious conversions can change that.

3. Alcoholics may not know when to save themselves, and may need help [he shoots down the "hitting bottom" myth]. Do you wait for a diabetic to go into a coma before you help them?

4. Treatment for the alcoholic must address the poor state of the alcoholic's health and nutrition. Alcoholic tremors, shaking, illusions, paranoia, etc. are caused by alcoholic malnutrition. Alcohol strips the body of water soluble vitamins, particularly the crucial B vitamins, and prevents the liver and other organs from repairing the body.

The one section of the book I don't agree with concerns the role of government/public agencies in alcoholism treatment. Milam expects too much of them. But that does not affect the brilliance of this book.

In the reviews here, there are some criticisms that Milam describes only "worst case" scenarios. That is not correct. He clearly describes all the stages of alcoholism, from the "I just want to have fun" stage to the lying in the gutter stage, and he recognizes that the disease progresses differently in people.

As an alcoholic who has been sober for twenty years, I can't recommend this book enough. It provides hard information, not moralizing.

I've authored four books on alcoholism, including Drunks, Drugs & Debits: How to Recognize Addicts and Avoid Financial Abuse and Alcoholism Myths and Realities: Removing the Stigma of Society's most Destructive Disease. This was one of perhaps at most a dozen books that were instrumental in helping me develop my ideas.

Under the Influence is a magnificent book. It thoroughly debunks the "mental health model" of addiction that misinforms so many. That alcoholism is biological is supported by the authors' detailed and thorough explanation of brain poisoning and adaptation to the drug we call alcohol. It is clear that this poisoning causes the alcohol addict to engage in destructive behaviors, both during and in-between drinking episodes.

The stages of alcoholism are beautifully described. The fact that there is an early stage vastly different from latter stages, makes sense of what seems a paradox: the high-functioning alcoholic. As few as one in a thousand observers ever identify these as such. This is terribly unfortunate, since the behaviors of the early stage addict can be so destructive and adversely affect so many.

There is a superb explanation of the nutritional damage that all alcoholics experience, along with the now well-known sugar connection. Under the Influence contains an excellent summary of diseases found in latter-stage alcoholics, including cancer and heart disease. At the same time, it has one of the best summaries that can be found of the behavioral signs and symptoms of addiction, including those that can be observed in early-stage alcohol addicts (which I describe in far greater detail in How to Spot Hidden Alcoholics: Using Behavioral Clues to Recognize Addiction in Its Early Stages. The fact that medical doctors often feed the addiction with other drugs is addressed, a clue to the idea that identification of alcoholics is, perhaps, best done at the grassroots level, by those who live with it (which I explain in great depth in Drunks, Drugs & Debits: How to Recognize Addicts and Avoid Financial Abuse.

This wonderful book has an excellent discussion of intervention and the reasons we don't need to wait for the addict's life to completely fall apart (and why it may be dangerous to the non-addict observer to delay). A proper professionally-aided intervention could include the employer and/or criminal justice system, and may be the more successful because of such involvement.

Finally, there is an illuminating discussion of the disease concept and the fact that the alcoholic must be held responsible. He must be counseled that he has a disease that causes him to process the drug differently than do non-addicts, and this differential processing results in the destructive behaviors that the rest of us bear the brunt of. One may reasonably conclude that he must be required to experience consequences for his drinking, which I dub "uncompromising disenabling" in Drunks, Drugs & Debits: How to Recognize Addicts and Avoid Financial Abuse.

Under the Influence may be 20 years old. However, its message and the vast majority of the research that went into it is timeless. I have read over 100 books on the subject. This is one of, perhaps, only seven or eight absolutely essential books on alcoholism. Because alcohol addiction affects everyone, it should be owned by all.

I have now read five books on this subject, due to family members and a dear friend being alcoholics. This is the most readable, "states it like it is," book I have read. Many, many questions are answered when reading this book. For me, of particular interest, was Chapter Five, wherein "The Protracted Withdrawal Syndrome" is described...it explains my friend exactly, and the doctors (three so far) are not picking up on his being in this stage, even tho they know he is an alcoholic! The information on types of food is especially good, and the authors are correct, that FEW (if any) doctors discuss the very important role of nutrition counseling!! I am getting three of these for family and friends and feel it will really help them understand others and themselves. I am most pleased to see that it is still in print. I got my copy from a friend about a year ago and just started re-reading it and realized it just "hits the bullet" as the saying goes, and is one that the alcoholism counselor (that originally gave it to me), had UNDERLINED and highly recommended.

This book is a real eye-opener, dispelling the myth that alcoholism is simply "moral weakness". As a member of AA I found the information to be an excellent supplement to the AA program. The explanation of the physiological impact of alcohol is clear and easily understood. I would recommend this book to anyone who wonders why alcoholics keep drinking.

For many alcoholics and those who live with them, it's not enough to know that this disease is a mysterious "allergy." Under the Influence explains the physical aspects of alcoholism in a matter-of-fact, easily readable form. The authors follow the progressive stages of alcoholism with clear descriptions of what the disease does to the way the liver, the brain, and the emotions respond to alcohol at each stage.

This book explains how the bodies of alcoholics metabolize liquor differently from those of non-alcoholics, and the changes in the brain that take place over years of continued drinking. (It confirms, for example, the observation that many late-stage alcoholics' function deteriorates as they go without liquor for a number of hours). After a complete description of the stages of alcoholism, it provides some insight on intervention and treatment, and some valuable information about treating the physical aspects of the disease in sobriety, with proper diet and rest in addition to AA attendance.

Nothing in Under the Influence will replace the role of the experience, strength and hope of other alcoholics in helping alcoholics recover. Yet this book provides valuable information, especially about the often-overlooked physical aspects of the three-fold disease of alcoholism.

This small book is still the most helpful tool for those who wish accurate information about the physical and psychological aspects of alcoholism. The disease of alcoholism is still misunderstood and to many people remains a moral problem or a failure of will power. While there has been progress in the treatment of many diseases over the past 20 years, there has been little change in the outlook for a cure for alcoholism. This book explains the physical and psychological disease in a way that can be easily understood. I have used this book for 22 years and have provided it to persons who wish to recover from the disease, always to good effect. And I am so grateful that it continues to be in print.

This is a hard-hitting exposé of the institutionalized and moralist cant surrounding alcoholism and its treatment. This is a classic of informative literature, partly a fine bit of muckraking journalism, partly a public service report on the scientific findings, and partly a "how to" program to address the epidemic. Although written almost twenty years ago, this little paperback still packs a punch against an enemy that is still all too much with us. Milan and Ketcham employ a straight-forward, fact-filled, uncluttered prose style to make it clear to any but the brain dead that alcoholism is a physiological disease and NOT a psychological problem based on a character flaw and/or lack of will power. Read this and you will no longer put down the alcoholic as some kind of moral degenerate, but will recognize that if your body chemistry were a little altered, you do might well be a victim.

I can say this because both my mother and father were alcoholics, and I know the only thing that kept me from joining them was the fact that I couldn't stand the headaches and nausea that came with "overindulgence." I apparently inherited the physiologic trait common to, e.g., Italian, Jewish and Asian peoples (there's a chart on p. 45 showing susceptibility by ethnicity) protecting me from alcoholism. It wasn't due to any superior morality or advanced character development on my part that I avoided the horror of alcoholism. It's more like having black skin that protects against skin cancer. Is black skin morally superior to white skin? Or, are sickle blood cells evidence of an elevated will to resist malaria? I don't think so. Thanks to this book I can see that I was lucky: I am not an alcoholic because my internal chemistry is not disrupted by alcohol as it is with alcoholics. That's it. Pure and simple.

Unfortunately many people, including--as this book points out--doctors, psychiatrists, members of the clergy, government officials and others in a position to help or hinder, still think of alcoholism in moralist and psychological terms. As Milan and Ketcham make clear this ignorant and prejudiced attitude not only doesn't help the alcoholic and his long-suffering family, it hinders treatment. The authors are vehement on this point. On page 195, for example, they write (citing Joseph Pursch): "...physician ignorance about alcoholism and prejudice toward alcoholics are the major obstacles to effective treatment." Strong words indeed, but not surprising. Most doctors were too busy in medical school to get an education, and too busy with patients (and I must say, climbing up the hill of worldly success) afterwards to catch up. This includes psychiatrists. As the authors point out these "professionals" routinely prescribed tranquilizers and other drugs pharmacologically similar to alcohol to alcoholics, drugs to which alcoholics have a cross-tolerance, a situation that not only led to a double addiction, but was, in some cases, life-threatening.

Professionals who offer counseling and psychotherapy to alcoholics are also taken to task by the authors: "Psychotherapy diverts attention from the physical causes of the disease, compounds the alcoholic's guilt and shame, and aggravates rather than alleviates his problems" (p. 14). "A[lcoholics] A[nonymous] members are all too aware of the condescension and judgmental attitudes about alcoholism which pervade the conventional health agencies. They have been drugged with tranquilizers and sedatives, have spent expensive and fruitless years in psychotherapy, and have endured indifferent and even hostile professional attitudes toward them and their disease" (p. 132).

So-called moral leaders of public opinion are also rightly chastised for their ignorance and lofty (and phony) moral tone. Ex-California Congressman Robert K. Dornan, who is quoted as seeing alcoholism as "an absence of self-discipline," and columnist Jack Anderson, who sees alcoholism as "a personal problem" are examples cited on page 7, although if the authors had wanted to, they could have filled volumes with such inanities. Government agencies are also in the thick of the stupidity. Particularly interesting (and telling) is this bit of sly of hand reported on pages 187-188: In the government-funded Rand Report of 1976 the term "recovery" was replaced with the broader term "remission" so that it would appear that some alcoholics were in "remission" although they were still swilling down something less than three ounces of pure alcohol per day. (Three ounces of alcohol is about what you'd get in 21 ounces of table wine or more than four cans of beer!) This allowed "treatment centers which embraced this definition of remission to claim up to 80 percent success rates--even though most of the alcoholics so labeled were still drinking."

Even Alcoholics Anonymous which the authors acknowledge several times as the best recovery program in existence, could use some updating based on the reality of the disease nature of alcoholism. Step four, for example, of the12-step program ("Made a searching and fearless moral inventory") could be modified to refer to the alcoholic's conduct AFTER detoxification and the recovery process. That way a clear distinction is made between behavior caused by alcoholism and behavior over which the alcoholic now has control.

One question: Now that the new millennium is upon us, have things gotten any better? Have the medical and counseling professions gotten the word on the true nature of alcoholism, and is the disease being treated as a disease? Not being in the field, I don't know; but I suspect that Katherine Ketcham's new book (which I am going to read next) Beyond the Influence: Understanding and Defeating Alcoholism (2000) will provide the answer.

Before I read this book I had the slightest clue about my past and present relationship with alcohol. I was especially intruiged when they named off to the dime, the feelings of anxiety, isolation, guilt, and shame that I was feeling. All this time I was looking for reasons to blame my family for the way that I felt. While reading this book, I realized that my binge drinking on the weekends had been deteriorating my relationships with real people. And alcohol, my best friend, was the one doing it! This book offers fundamental information about alcohol and alcoholism that every single person should know.

This is an excellent book offering the best explanation of alcoholism. My daughter is an alcoholic and this is THE book that helped us understand what we needed to do; it set us free of guilt; it helped us focus on the problem. She is in a center that uses this philosophy for treatment and we are hopeful that this time treatment will be successful.

When I went into treatment 9 years ago, I was required to read this book. I read it in one night while I detoxed! That's how easy it is to read and to comprehend. It answered so many questions I had about my drinking and placed me squarely on the path to recovery like nothing else had done except spiritual experiences. Whenever I sponsor a newcomer, I require that they read Under The Influence, and if they have a reading disability, I read it to them.