A competent mother can make up for most of the deficiencies resulting from a father’s alcoholism. So pronounced are the capabilities of alcoholics’ wives to sustain the roles proper to their husbands that the children do not commonly suffer material privation. Myers1 found that the children of a series of London alcoholics rarely went hungry and were always well cared for. Inevitably the personal development of the children of an alcoholic must be anomalous; for one thing there are likely to be unwanted changes of home with consequent disruptions of schooling and of friendships. But this need not give rise to any adult abnormality. They are certain to have a decided attitude towards drinkers and drinking. Either they tend to drink excessively themselves or they are strongly opposed to it. Sons of alcoholics frequently become alcoholic themselves. Their personalities have been labelled2 ‘passive-aggressive’; they often have serious difficulty in expressing assertive impulses and in knowing what to do with angry feelings aroused by frustrating situations. Alcoholics often stress that they have perceived their drinking fathers as nebulous family members, inaccessible when their presence was longed for. These sons envied other boys who were proud of fathers that took an interest in their achievements and played with them.
The alcoholic father is often as good as absent, always liable to erupt unpredictably with some behaviour which embarrasses or wounds the family. The children quickly pick up cues from their mother, leading them to look down on their father and condemn his standards and actions. A son of such a father never loses the impact made on him by the paternal failure. One alcoholic would never enter a hotel; he could not bring himself to do so, being constrained by recollections of repeated humiliations during his adolescence caused by his father’s uncouth and uninhibited behaviour to waitresses. He felt himself enfeebled and deprived through never having had a father who could be respected.
The effect of an alcoholic parent persists throughout life; its influence is subtie and strong. Attitudes are conditioned by it, whether or not the individual is aware of this. We have seen that a girl whose father was an alcoholic will often marry a passive man, perhaps even an alcoholic himself. She may repeat the same pattern two or three times. An alcoholic father provides an unserviceable personality model.
In Sweden children of alcoholic fathers were compared with similar children from non-alcoholic families.1 The ages ranged from 4 to 12 years. (Divorce or separation had taken place in 28 per cent of the alcoholic families and in 4 per cent of the control families.) One of the comparisons made was in attendances at hospital. Twenty-four per cent from the alcoholics’ families, and a similar figure, 19 per cent, from the controls’ had been to hospital. But whereas two thirds of the control children had organic causes found to account for their physical symptoms, this was true for only a quarter of the alcoholics’ children. Three quarters of them were not considered to have an organic basis to explain their complaints. Attendances at child guidance clinics, for psychiatric disorder, were the same for the two groups of children. When their teachers were questioned they rated 48 per cent of children from alcoholic families as problem children, but only 10 per cent of those from non-alcoholic homes.
Tension in the child shows not only in the form of illnesses and abnormal behaviour at school but also by disturbed relationships at home. Where the father is alcoholic an intensified relationship is set up between the children and their mother; she may thus unwittingly become the recipient of hostile and resentful feelings which the total family situation has engendered in the children. In carrying out the breadwinning role, the mother has perforce to neglect some of her other functions. Nylander found that the alcoholics’ children who had had to be admitted to hospital for psychiatric care seemed to have more problems concerning their mothers than their fathers.
The effect upon the child of an alcoholic parent is considerably reduced if the other parent is able to provide a sympathetic explanation of the condition in terms of illness. This enables the child to understand why the father fails so grossly in his paternal role, and so spares the growing child some of the harmful effects which result when a father is viewed with contempt.
Treatment of an alcoholic is a large endeavour and the programme for any particular patient has to be designed to suit his individual needs. We can, however, distinguish separate phases.
The first phase is acceptance of the need for treatment. It is hard for non-alcoholics to realize what a surrender of pride is involved. The alcoholic has to appreciate that he is an alcoholic and that he must stop drinking. This may not be too difficult. His life circumstances will force the knowledge on him and as we have already seen he has probably made one or more unsuccessful attempts to give up on his own. The next step follows from this and is far harder for him to adopt. He needs to accept that he cannot become abstinent without help. Despite the evidence to the contrary provided by repeated failures in the past, alcoholics often insist that they can overcome their addiction on their own. Physicians in general hospitals who deal with the medical crises of alcoholism are constandy being told: ‘ This time I’m determined to give it up. I can do it myself. This time I know I’ll give it up.’
Spontaneous cures of alcoholism are reported. In many of them religious conversion plays a part. However, they are so rare that the National Council on Alcoholism advises: ‘It can be done but the odds are against trying.’
Before any treatment can be effective this attitude has to be altered; for the doctor it may be a painstaking task to help his patient overcome it. Partly it is based on the fear of having to give up drinking that is mixed with his desire to do so. Although he sees how it has ruined his life the alcoholic at the same time knows that, so far, alcohol has been the only solution he has found for his problems.’He is not ready to give it up until he is sure that there is another course open to him.
The second phase, which may or may not be necessary, consists of general medical treatment of the physical diseases wrought by alcoholism. Alcoholic gastritis subsides spontaneously when drinking is given up and with it goes much of the nausea and lack of appetite of which the alcoholic complains. Indeed the loss of these symptoms is often the first benefit noted by the newly abstinent alcoholic. Cirrhosis of the liver requires a much more complicated regime of management. The nutritional disorders and the vitamin deficiency diseases are dealt with by restoring an adequate diet and by giving vitamin supplements, in particular one constituent of the B complex, thiamine. The disorders of the nervous system, if they are not too advanced, respond to this therapy but they do so very slowly and in some cases without full restitution to normal.
Withdrawal symptoms may also need active physical measures for their treatment or prevention.
Withdrawal symptoms can fortunately be averted or abated without the necessity of giving more alcohol (though in the past this means of treatment was used). Nowadays one of the tranquillizing drugs is given, generally chlorpromazine (largactil). It is prescribed to prevent the development of withdrawal symptoms when these can be anticipated, and to modify and abate them when they occur. This drug, when it is administered in adequate dosage, makes the full-blown picture of florid delirium tremens now not nearly as common as it used to be; and if the condition has developed it is capable of terminating it within a few hours.
Our principal concern in this chapter is the management of alcohol addiction. An alcoholic can embark on this phase when he has accepted the need for treatment and when the necessary medical measures have restored his physical health. He is asking for help, he is ready for it and this is the time when he should get it. He is often advised to enter hospital at the beginning of his anti-addictive treatment. There are many reasons for this but the most important is that in hospital he is removed from alcohol. Until he is sober, until his thinking processes are back to normal, there can be no adequate communication between the doctor and the patient. The doctor cannot learn the significant details of his particular problems, and the patient cannot command the foresight necessary to examine his own situation and to respond to the physician’s approach. After some weeks (the time varies with the patient’s rate of progress and the physician’s practice) he leaves hospital to continue active treatment as an out-patient.
The techniques of treatment that are used during both inpatient and out-patient periods are various, being designed to protect the patient from lapsing into renewed drinking, to enable him to appreciate the reasons for his dependence on alcohol and hence to overcome them and to foster his resources for coping better socially.
The alcoholic who is going to give up drinking will inevitably have to depend on and trust somebody whom he accepts as prepared to help him and has the necessary skills. If he decides on medical treatment there are a number of approaches he can make. In the first instance he may attend his general practitioner.