It is absolutely essential that the man who wishes to help another who has lost control must first accurately understand not only his mental imperfection, if there is any, but his general psychological state. The line between sobriety and drunkenness in the man who has once lost control is almost indistinguishable; it is impossible when talking with him to be sure whether you are talking with the normal mind or with the alcoholic mind. Having once made certain that it is the normal mind to which you are presenting your arguments, your next necessary step is to strip away every mental reservation. Thousands of men who have honestly desired to leave off alcohol have been prevented from doing so by their own secretiveness; it is this mental reservation which has been responsible for many of the failures of my treatment.

While the absolute inheritance of a craving for alcohol is, in my experience, a rare thing—so rare as to seem almost negligible, there is no doubt, on the other hand, that many men and women inherit imperfect nervous systems. An imperfect nervous system, if it knew the reason for its own imperfections, might naturally crave alcohol; but inasmuch as such an imperfect system is not naturally accompanied by this instinctive knowledge, the theory of hereditary alcoholic craving must be set aside as untenable. I absolutely deny, therefore, the possibility of such hereditary tendencies. I know that by so doing I may cause acute mental discomfort to those who have made of heredity an excuse for their errors not only to their friends, but in their own minds. The old cloak of heredity has been worn to tatters and must be discarded. Who among us cannot follow up the branches of his family-tree and find somewhere upon one side or the other a person of alcoholic tendencies? In ninety families out of a hundred any one who looks can find such an excuse for his own weakness. In thousands of instances physicians have taken seriously such excuses offered by their patients, but the doctor who listens to his patient’s babble of heredity is sure to be misled, and the patient who believes this too commonly accepted theory robs himself of his strongest weapon against alcohol—his own conviction of his personal responsibility and power for self-help.

ALCOHOLISM AS A DISEASE

We hear much sympathetic talk of the “disease of alcoholism.” This is only in a sense true. It is not a case of helpless chance, for the difficulty has been manufactured and developed by man himself. The alcoholic, mentally weakened by the reaction of the stimulant, is of all people most likely to exhibit that most striking evidence of weakness—a craving for sympathy rather than for blame. Habitual alcoholics continually plead for sympathy with mothers, fathers, wives, and friends; and too often they are granted not only pity, but, what is worse, toleration. The sanatorium promoters and proprietors of fake cures continually harp on alcoholism as a disease; and even a few scientists, who should know better, have been misled into an acceptance of this theory. Doctors should be the first to knock from under their patients the psychologically harmful props of the heredity theories.

The first thing a physician must do when dealing with an alcoholic is to cut every string of excuse which lies between him and his habit. He must leave nothing of this sort to which the drinker may cling. Sickness, worry, unhappy circumstances of whatever sort must immediately be eliminated as excuses for alcoholic indulgence. If they are not, the patient, although he may gain for a time the mastery over his habit, will presently be certain to find an excuse in his own mind to justify a return to it. Then will come a new downfall. There must be no reservations either in the attitude of the doctor or his patient or in the mental attitude of the patient toward himself.

MENTAL ATTITUDE A VITAL CONSIDERATION

The possibilities of medical help for the alcoholic have been exhausted when the patient has been freed from the effect of the stimulant and put in a physical condition wherein he feels no inclination toward more alcohol. Great psychological assistance may accompany this definite medical treatment when the patient’s physical craving for alcohol has once been eliminated if the physician brings him into a mental state which gives him confidence in his own ability to keep away from stimulants in the future.

I cannot too strongly emphasize the fact that no cure exists, or ever will exist, for alcoholism. Its effects may be eliminated, and the victim’s physical condition become so greatly improved that weakness will not make him yearn for stimulation; but this does not constitute a cure. Nothing except a man’s own mind, whether the treatment extends over six weeks, six months, or six years, can ever relieve him of the danger of a relapse into alcoholism. In most cases a definite medical treatment is the intelligent beginning of help, but no medical treatment, no matter how successful, can compass that victory which a man must win by means of his own determination.

THE CHRONIC ALCOHOLIC

The physician still regards such cases only from the point of view of physical hazard. It is my opinion that in alcoholic cases the physical hazard is the matter of least importance, and that the world at large has devoted altogether too much effort to its endeavors to preserve chronic alcoholics, just as it has devoted far too little effort to rescue the victims of drugs. It is my opinion that among alcoholics, no matter how worthy they may have been before they lost control, not more than twenty-five per cent. of those whose addiction has become chronic are curable; that is to say, promise any reward whatever for salvage work. The world must remember that the inflamed brain leads to everything on earth which is not worth while, and therefore that the man whose brain has for any considerable period of time been in this condition must have enormously deteriorated. It must also be remembered that at least one half of the world’s chronic alcoholics have syphilitic histories.