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ALCOHOL PROBLEMS: HISTORY OF ALCOHOL TREATMENT EFFORTS.

The first serious considerations of the problem of inebriety, as it was called, came in the eighteenth and nineteenth centuries. Two famous writings addressed the problem in what seemed to be a new light. Although their work on the physical aspects of alcohol became fodder for the temperance zealots, both Dr. Benjamin Rush and Dr. Thomas Trotter seriously considered the effects of alcohol in a scientific way. Rush, a signer of the Declaration of Independence and a surgeon general of the Army, wrote a lengthy treatise with an equally lengthy title, "An Inquiry into the Effects of Ardent Spirits on the Human Body and Mind, with an Account of the Means of Preventing and the Remedies of Curing Them." Rush's book is a compendium of the attitudes of the time, given weight by scholarly treatment. The more important of the two, and the first scientific formulation of drunkenness on record, is the classic work of Trotter, an Edinburgh physician. In 1804 he wrote "An Essay, Medical, Philosophical, and Chemical, on Drunkenness and Its Effects on the Human Body." He states: "In the writings of medicine, we find drunkenness only cursorily mentioned among the powers that injure health....The priesthood hath poured forth its anathemas from the pulpit; and the moralist, no less severe, hath declaimed against it as a vice degrading to our nature." He then gets down to the heart of the matter: "In medical language, I consider drunkenness, strictly speaking, to be a disease, produced by a remote cause, and giving birth to actions and movements in the living body that disorder the functions of health."

Trotter did not gain many adherents to his position, but small efforts were also being made in the United States at the time. Around the 1830s, in Massachusetts, Connecticut, and New York, small groups were forming to reform "intemperate persons" by hospitalizing them, instead of sending them to jail or the workhouse. The new groups, started by the medical superintendent of Worcester, Massachusetts, Dr. Samuel Woodward, and a Dr. Eh Todd, did not see inebriates in the same class with criminals, the indigent, or the insane. Between 1841 and 1874 eleven nonprofit hospitals and houses were set up. In 1876 the Journal of Inebriety started publication to advance their views and findings. These efforts were taking place against the background of the temperance movement. Naturally, there was tremendous popular opposition from both the church and the legislative halls. The Journal was not prestigious by the standards of the medical journals of that time, and before Prohibition the hospitals were closed and the Journal had folded.

Another group also briefly flourished. The Washington Temperance Society began in Chase's Tavern in Baltimore in 1840. Six drinking buddies were the founders, and they each agreed to bring a friend to the next meeting. In a few months parades and public meetings were being held to spread the message: "Drunkard! Come up here! You can reform. We don't slight the drunkard. We love him!" At the peak of its success in 1844, the membership consisted of 100,000 "reformed common drunkards" and 300,000 "common tipplers." A women's auxiliary group, the Martha Washington Society, was dedicated to feeding and clothing the poor. Based on the promise of religious salvation, the Washington Temperance Society was organized in much the same way as the ordinary temperance groups, but with one difference. It was founded on the basis of one drunkard helping another, of drunks telling their story in public. The society prospered all over the East Coast as far north as New Hampshire. A hospital, the Home for the Fallen, was established in Boston and still exists under a different name. There are many similarities between the Washington Society and Alcoholics Anonymous (AA): alcoholics helping each other, regular meetings, sharing experiences, fellowship, reliance on a Higher Power, and total abstention from alcohol. The society was, however, caught up in the frenzies of the total temperance movement: the controversies, power struggles, religious fights, and ego trips of the leaders. By 1848, 8 short years after its founding, it was absorbed into the total prohibition movement. The treatment of the alcoholic became unimportant in the heat of the argument.

Recognition of the alcoholic as a sick person did not reemerge until comparatively recently. The gathering of a group of scientists at Yale's Laboratory of Applied Psychology (later the Laboratory of Applied Biodynamics) and the Fellowship of Alcoholics Anonymous, both begun in the 1930s, were instrumental in bringing this about. Also in the 1930s a recovered Bostonian alcoholic, Richard Peabody, first began to apply psychological methods to the cure of alcoholics. He replaced the terms "drunk" and "drunkenness" with the more scientific and less judgmental "alcoholic" and "alcoholism." At Yale, Yandell Henderson, Howard Haggard, Leon Greenberg, and later E. M. Jellinek founded the Quarterly Journal of Studies on Alcohol (QJSA)- since 1975 known as the Journal of Studies on Alcohol. Unlike the earlier Journal of Inebriety, the QJSA had a sound scientific footing and became the mouthpiece for alcohol information. Starting with Haggard's work on alcohol metabolism, these efforts marked the first attempt to put the study of alcohol and alcohol problems in a respectable up-to-date framework. Jellinek's masterwork, The Disease Concept of Alcoholism, was a product of the Yale experience. The Yale Center of Alcohol Studies and the Classified Abstract Archive of Alcohol Literature were established. The Yale Plan Clinic was also set up to diagnose and treat alcoholism. The Yale Summer School of Alcohol Studies, now the Rutgers School, educated professionals and laypeople from all walks of life. Yale's prestigious influence had far-reaching effects. The National Council on Alcoholism (NCA), a volunteer organization, also grew out of the Yale School. It was founded in 1944 by the joint efforts of Jellinek and Marty Mann, a recovered alcoholic and the NCA's first president, to provide public information and education about alcohol.

On the other side of the coin, Alcoholics Anonymous was having more success in treating alcoholics than any other group. AA grew, and in 1983 it estimated a membership of 1 million in both America and abroad. Its members became influential in removing the stigma that had been so long attached to the alcoholic. Lawyers, businesspeople, teachers, people from every sector of society began to recover. They could be seen leading useful, normal lives without alcohol. (More will be said later on the origins and program of AA itself.) The successful recoveries of its members have unquestionably influenced the course of recent developments.

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