Ten of millions Americans suffer from alcoholism, yet most people still wrongly believe that alcoholism is a psychological or moral problem, and that it can be cured by psychotherapy or sheer will power. Based on groundbreaking scientific research, Under The Influence examine the physical factors that set alcoholics and non-alcoholics apart, and suggests a bold, stigma-free way of understanding and treating the alcoholic.

How to tell if someone you know is an alcoholic.

The progressive stages of alcoholism.

How to get an alcoholic into treatment -- and how to choose a treatment program.

Why frequently prescribed drugs can be dangerous -- even fatal -- for alcoholics.

How to ensure a lasting recovery.

Ten of millions Americans suffer from alcoholism, yet most people still wrongly believe that alcoholism is a psychological or moral problem, and that it can be cured by psychotherapy or sheer will power. Based on groundbreaking scientific research, "Under The Influence examine the physical factors that set alcoholics and non-alcoholics apart, and suggests a bold, stigma-free way of understanding and treating the alcoholic.
How to tell if someone you know is an alcoholic.
The progressive stages of alcoholism.
How to get an alcoholic into treatment -- and how to choose a treatment program.
Why frequently prescribed drugs can be dangerous -- even fatal -- for alcoholics.
How to ensure a lasting recovery.

Katherine Ketcham has been writing nonfiction books for forty years. Her work has been published in sixteen foreign languages and has sold nearly one million copies. She founded and serves on the board of a grassroots nonprofit organization called Trilogy Recovery Community, which helps youth and their family members dealing with alcohol and other drug problems. Ketcham lives in Walla Walla, Washington.

1
Every Human Soul
 
Every human soul is worth saving; but … if a choice is to be made, drunkards are about the last class to be taken hold of.
From “Drunkenness a Vice, Not a Disease,”
by J. E. Todd, 1882
 
Bob is 26 years old and a talented song writer. He says he drinks heavily for any number of reasons—when he is depressed because his work is not progressing well, elated because he finished a song, frightened about his future, or concerned about his financial problems.
 
When he drinks, he has problems. His car is scarred with dents and scratches from his erratic driving. He sometimes “forgets” what he did while he was drinking, and the next day he tries to piece together the night before. On one drunk, he broke his leg jumping over a fence. His wife takes a lot of abuse when Bob drinks. He hasn’t hurt her badly, just slapped her around some. After a New Year’s Eve party, Bob was driving, drunk, and his wife asked him to let her drive. Furious, he stopped the car, leaned across her, opened the door, and pushed her out. Then he sped away, leaving her stranded on the highway.
 
After these episodes, Bob feels guilty and ashamed and vows to cut back on his drinking. He begs his wife’s forgiveness, and together they try to understand what bothers him when he is drinking and why he cannot just stop after a few drinks. Bob thinks the problem is psychological. He tells his wife that his career is difficult and demanding; the ups are euphoric, he explains, but the downs are devastating. Anyone would drink in this work, he tells her; it just comes with the territory. His wife blames the heavy drinking and violent behavior on his upbringing. His mother was a big drinker and set a bad example; furthermore, she never gave her kids any love or affection. Bob is just insecure, his wife insists. He needs understanding and tender loving care. She knows that he is a sensitive, loving man, and she believes she can be most helpful by supporting and helping him through the rough times.
 
Both Bob and his wife believe the drinking is just a symptom of some deep insecurity or emotional hangup. Once Bob becomes successful and their financial situation is secure, they believe he will have the confidence to work his problems out more rationally. “It is just a temporary problem,” they agree.
 
Bob is an alcoholic. His wife, doctor, friends, and relatives do not know that he is addicted to alcohol. He does not know it either, although he is often afraid that something terrible is happening to him. He worries that he may have some kind of mental problem, although he struggles with these fears by himself, convinced that once he admits them they will be confirmed. He is deeply ashamed of himself and full of guilt about his inability to control his drinking and keep his promises to his wife.
 
What will happen to Bob? If he is like most of the 10 million alcoholics in the United States,* his children will be ashamed of him, his friends will shun him, his doctors will despair of helping him, and his wife will finally leave him. His personality will be gradually distorted, his talents and intelligence wasted, and his integrity and self-respect eroded. He will take tranquilizers and sedatives in an effort to combat his depression and anxiety. He will switch doctors, hoping to find one who can tell him what is wrong. He will see a psychiatrist and spend countless hours and thousands of dollars trying to dig up the roots of his unhappiness. He will be reprimanded by his boss, and eventually he will be fired.
 
Throughout it all, he will drink. He will try to stop drinking, and sometimes he will succeed. But after a week or a month, he will start again. He will shake, sweat, and feel sick to his stomach when he stops drinking. As he continues to drink, these withdrawal symptoms will get worse, and he will drink more, and more often, to relieve his pain.
 
As his disease progresses, his blood pressure will escalate, and his depression will increase. The drinking will not stop but instead will become more and more of a problem, causing difficulties at home, on the job, with the children. His heart, liver, and nervous system will begin to function less effectively. He will be hospitalized from time to time for various complications caused by his excessive drinking.
 
He will have numerous accidents—falling down the stairs or off a ladder, driving his car into a tree, overdosing on sleeping pills or tranquilizers—and one of these accidents may kill him. He may commit suicide. Or he may eventually die from “acute alcohol poisoning,” cirrhosis of the liver, heart or respiratory failure, pneumonia, or infection.
 
Most alcoholics will die 10 to 12 years earlier than their nonalcoholic friends. Most will never receive treatment for their primary disease of alcoholism. Their death certificates will typically state “heart failure,” “accident victim,” “suicide,” or “respiratory failure” as the cause of death. The chances are that no one—physician, social worker, family member, or alcoholic—will diagnose the cause of the problem as addiction to alcohol.
 
While thousands of alcoholics like Bob die every year, scientists, physicians, and professional alcoholism specialists argue endlessly about the nature of the disease that destroys them. The people involved in trying to understand alcoholism—and that includes psychologists, psychiatrists, physicians, nutritionists, biologists, neurophysiologists, biochemists, anthropologists, and sociologists—are sunk in a morass of conflict and confusion, admitting to prejudiced opinion, self-interest, and a deep distrust of others in the field. These professionals cannot agree about the causes of the disease, how it should be treated, or how it can be prevented.
 
The problem is deeper than a superficial disagreement among scholars. Violent feeling lurks here. Hatred, distrust, and prejudices abound. Profound insecurities and long-standing feuds smolder. Each scientist or research team appears to be working in a narrow compartment, oblivious of work conducted by others outside their special field. Scientists in the laboratory accuse the clinicians, who work directly with alcoholics, of ignoring scientific data and conforming to old-fashioned and out-dated treatment methods. Clinicians accuse the scientists of dismissing all first-hand experiences with alcoholics as “nonscientific” and therefore invalid. Government administrators chide the scientists for their “intellectual arrogance,” while the scientists accuse the bureaucrats of pandering to fads and special interests. Psychiatrists fret about being displaced from their positions as primary therapists and treatment personnel by a new wave of paraprofessionals specifically trained in alcoholism diagnosis and treatment.
 
These deep and painful schisms were dramatized at a recent conference which brought together eminent researchers and clinicians to discuss research priorities on alcohol.1 The research priorities were put on the back burner, however, while the professionals spent three days attempting to sort out the confusions, hostilities, and deep divisions which plague the field. As one participant summarized the situation:
 
. . this topic is one of deep, immediate emotional cleavages fashioned through generations by a variety of traditional beliefs of moral, political, religious, educational, social class and other systems—cleavages which are carried by researchers and everybody else whether they like it or not.
 
Quite apart from what general publics may think about alcohol researchers, it is hard to be unaware that representatives of one research discipline frequently feel that other disciplines dealing with alcohol-man-and-society are somewhat stupid on this topic.
 
Another prestigious researcher compared the alcoholism field to a chaotic collage created by children:
 
[The field of alcoholism] reminds me of a large wall mural in a classroom, upon which the children worked for several years.… The mural did not have any central or unifying themes, save that it presented the opportunity for many contributors to add their personal ideograph.
 
Because of their confessed prejudices and self-interest, it should come as no surprise that these professionals are unable to pull the field out of its morass and invest it with new enthusiasm and energy. They have ceased to be part of the solution to the problem and instead have become part of the problem. “Clearly the current generation of alcohol researchers is too far gone,” a participant concluded, “too steeped in our own disciplinary affiliations to be of much use; our shackles have become comfortable.”