We have left to the last an unusual drinking pattern which is not classifiable into any of the previous groups.
There are people who for three or six months, and sometimes longer, drink only socially, if at all. They then suddenly start to drink excessively, for days on end, drinking all the time, neglecting all their responsibilities at work or to their families. Sometimes they do serious damage to themselves or to others during the bouts. Days or weeks later they just as suddenly stop.
A 45-year-old male schoolteacher drank excessively in bouts of two to three days, with approximately four months between. The longest time between bouts was fourteen months. Ordinarily I never have more than a sherry. Once I start drinking more, just civilized social drinking, it brings the possibility of a bout nearer reality. I know when one is imminent. I think to myself, ‘I’m going to get drunk tonight and, God, how I dread it.’ When I start up, there seems to be a determined attitude to get really stinko, plastered. I’m determined then to stay drunk for forty-eight hours to three days, until I get into a thoroughly toxic state. All that will keep me quiet is more alcohol. Only drugs can get me out of the cycle, which I badly want to come to an end. I’ve never lost a job, but I’ve had to be hospitalized a number of times. It’s almost as if a bout is unconsciously planned. It happens when I feel: ‘Now I can let go, escape from things.’ First there’s the build-up, then the letting go. I have a spurt of ‘you only live once, to hell wifti it’. It’s a wild, exuberant, thoughtless, throw-it-down. I weep for my wife in many respects. I honestly don’t know what the solution is. I don’t know what to do about myself now.
For many months a bout drinker may be untroubled by any urge to drink and, in fact, may have been able to drink socially; but once the bout starts it progresses relendessly. A shopkeeper was seen after he had suffered from periodic drinking bouts for thirty years. He came for treatment because he felt that he could no longer bear the physical consequences of a drinking bout.
I get jittery, especially when I am trying to stop. What annoys me is that I can last for as long as ten months, but then it all starts up again. First I have an urge to start for two or three days, set off by fortuitous happenings, a drink advertisement which catches my eye or a brewery wagon passing. Then I succumb. I feel guilty about it soon after I have started, because I am a disgrace to my family. My daughter ignores me lately and she comes home late from school because she is sick of the sight of me; she wants to stay out of the house as much as possible rather than face the sight of me.
The great interest of bout drinking stems from this alternation of brief but grossly pathological drinking with long phases of normality. Periodic drinkers of this sort usually deny that any particular psychological stress is required to trigger off the drinking phases, nor can upsetting events be incriminated. This unusual form of drinking used to be called dipsomania or periodic alcoholism.
We have seen that the various patterns of abnormal drinking can be associated with disorders of personality (most cases come in this category), with underlying neurotic illness or with psychoses or underlying brain disease. Each of these characteristically sets up its own form of pathological use of alcohol and each requires a separate method of management. The global term of alcoholism is used to cover them all. But psychiatrists carry out a careful process of differentiation to determine the category in which a particular person belongs.