Signposts to Alcoholism

The patient came into the Yale Plan Clinic a jittery sack. The night before, for the 14th time in six years, he had been arrested for drunkenness. Obsessed by the idea that he had killed his brother (who had caught pneumonia while looking after him), he was in a suicidal mood. Medical Director Dr. Giorgio Lolli skipped preliminaries and applied emergency treatment: relieving the patient's sense of guilt. Said Dr. Lolli, 15 minutes later: "He came in a bum and went out a person. I think he'll come back this afternoon--sober." (He did.)

Some 450 alcoholics with colossal hangovers have shuffled a path to the ivied red house on Temple Street which houses Yale's New Haven clinic. By last week, the Yale Plan had started a national movement: at least five states (New Jersey, New Hampshire, Alabama, Oregon, Connecticut) and a dozen cities were studying or organizing similar clinics (Connecticut already had one in operation in Hartford). With the aid of Salvation Army workers, ministers, educators, and Alcoholics Anonymous (24,000 members), Yale was campaigning busily for free medical treatment for the nation's 750,000 chronic alcoholics.

The Treatment. The Yale Clinic offers no magic formula. Its only tools are 1) the ingenuity of the clinic's small staff of physicians, psychiatrists, psychologists and case workers; 2) a massive catalogue of facts about alcohol compiled by the University's Section on Alcohol Studies.

An alcoholic's hangover, says Dr. Lolli, differs fundamentally from that of a casual drinker: the alcoholic, after a drinking bout, is beset with uncontrollable tremors, nameless fears, insomnia, an enlarged liver, all sorts of neurotic digestive disorders. He badly needs food, because a prolonged diet of alcohol produces vitamin and mineral deficiencies.

Dr. Lolli's hangover treatment usually begins with sedatives, vitamins, a warm bath (to quiet the patient and help him sleep). The chief ingredient is psychotherapy, which starts almost at once, while the patient is most susceptible. First step: to relieve him of certain common misconceptions about his condition.

Misconception No. 1. Prolonged drinking, he thinks, has made him an irreparable physical wreck. The fact: alcohol weakens the body, but seldom damages it permanently. Aside from certain easily remediable ailments (such as a temporarily enlarged liver, vitamin deficiency diseases--e.g., pellagra), there are few disorders traceable to drinking. Cirrhosis of the liver, one of the few which seems to have a connection, attacks only 8% of drunkards (v. 1% in the general population).

Misconception No. 2. Drinking, he thinks, is the cause of his neuroses. The fact: drinking is the result, not the cause. Psychiatrists recognize only one mental disorder directly attributable to alcoholism: delirium tremens (which attacks 4% of alcoholics). According to Dr. Lolli, every alcoholic is a neurotic (or psychotic)--but the neurosis came first.

At the Yale Clinic, which charges no fees, psychiatric reassurance is combined with a few new wrinkles. One of them: group therapy. Selected groups of a dozen or so patients meet weekly to consider their problems and the Demon Rum. A modification of the Alcoholics Anonymous method (without the religious and confessional aspects), it has multiplied the number of patients that the clinic's limited staff can treat.

Because there is no real cure for alcoholism (a reformed drunkard is never more than one drink from disaster), Yale's alcohol researchers have concentrated on prevention. Last week Dr. Elvin M. Jellinek, the bustling director of their studies, reported a little progress: his investigators had discovered how to spot an incipient alcoholic. A drinker who 1) gulps his drinks, 2) sneaks a few on the side, 3) worries about his liquor consumption, 4) stops talking about his drinking, 5) begins to "pull blanks" (i.e., forgets what happened during his bouts) is likely to become a hopeless drunk within two years.

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