Chronic Alcoholism
The following is an excerpt from the book Don't Be Afraid! written by
Edward Spencer Cowles, M.D. and published in 1941. From today's
perspective some of this material may seem shocking, and yet,
pathetically humorous. This physician treated "chronic alcoholics" with
this method over a span of nearly 30 years. It would seem that Bill W.
knew of this method. He wrote in Alcoholics Anonymous (Page 140):
"I well remember the shock I received when a prominent doctor in Chicago
told me of cases where pressure of the spinal fluid actually ruptured the
brain. No wonder an alcoholic is strangely irrational. Who wouldn't be,
with such a fevered brain? Normal drinkers are not so affected, nor can
they understand the aberrations of the alcoholic."
Perhaps we are fortunate that Bill did not fall into Dr. Cowles' hands.
Chronic Alcoholism
Alcoholism is one of the oldest of human problems, the solution of which
has eluded scientists and social workers for generations.
Why do people drink to excess?
The number of those who drink to escape from worry, anxiety, or some
haunting fear is legion. These people drink not because they are
alcoholics but because they have a fear neurosis. With their feeling of
inward insecurity, they feel unable to tackle the work and the
responsibilities that are staring them in the face. They reach out for
alcohol as a crutch.
These men and women do not want to drink. Many of them actually dislike
the alcohol they say they cannot get along without. They know that the
alcohol makes them feel infinitely worse the next day, when their sense
of insecurity and nervousness is increased by the effect of alcohol on
the system. Yet even with this full knowledge, their present fear is so
acute that they feel they must have the temporary support they get from
drinking.
It is a very grave mistake to class these nervous cases as chronic
alcoholics no matter how much alcohol they consume to enable them to go
against their fears. No one is a chronic alcoholic whose spinal fluid
does not reveal intracranial pressure and the chemical changes that are
positive indication of the disease. To call a "heavy drinker" a "chronic
alcoholic" without absolute proof of his brain chemistry is as erroneous
as to call every underweight young woman with a cough "tubercular."
Chronic Alcoholism Is a Disease Not a Crime
No disease has aroused so much controversy and so many heated, violently
partisan debates as chronic alcoholism.
Long after intelligent people have ceased to think of insanity as
evidence of obsession by a devil that must be exorcised by prayer, magic
rites, or terrible beatings, after we have abandoned the old practice of
whipping all syphilitic patients on their admission to hospitals for
treatment, after we have accepted the fact that suicidal impulses are not
marks of moral depravity but symptoms of a melancholia that can result
from nervous fatigue, there are thousands of people alas, some of them
physicians-who continue to think of chronic alcoholics as creatures who
lack the moral integrity, sense of decency, self-respect, and will power
of normal men and women.
The chronic alcoholic is not a depraved individual, worthy only of
contempt. He is diseased. He is not a social leper but a very sick man.
Chronic alcoholism is not a crime. It is a definite brain-chemistry
disease. It can be diagnosed with chemical precision, and it can
definitely be cured. It is not a matter of morals or will power any more
than hay fever can be said to be. It is caused by a diseased condition of
the brain covering-not an infection but an irritation-that produces an
excess of brain fluid. The habitual drunkard craves liquor because of
intracranial pressure. He has a pressure many times above that of normal
individuals, even when he is not drinking.
Why, then, are some people chronic alcoholics and others not? Nearly
everyone, in these days, drinks now and then by social custom. Some take
a drink or two and stop. Others may take four or five drinks and some
persons more than that, without any apparent change in their
personalities. They may be a little gayer, a little more talkative, a
little freer in their conversation, but there is no other change. They
may wake up next morning with a headache, feeling irritable, but that is
as far as it goes. They do not go right on drinking that day and the next
until they land in a hospital.
The chronic alcoholic has no such power to stop. One drink may set him
off. Two drinks may change his personality completely. From a modest man,
he becomes a vulgar man. From a man of limited means, he becomes-in his
own ideas-a man of great wealth. Once a man of moderate language, now
foul words are on his lips. From a man of consideration at home, he
becomes jealous and abusive. His whole personality undergoes a change.
Some men may have been drinking for twenty years before alcohol begins to
effect this change in them. Others show the change after only a short
while. It is when the individual reaches the point that drinking changes
his personality, that he can truly be diagnosed as a "chronic alcoholic."
What Makes the Change in Personality?
The explanation is that the meninges of the brain set up an allergic
reaction to alcohol. The dose of alcohol necessary to bring about this
allergic response varies with the individual. Some individuals are more
susceptible than others.
I repeat, will power has nothing to do with this, any more than will
power, good intentions, and respect for one's family and one's social
position can keep the hayfever victim from sneezing when he walks through
a field of goldenrod.
The two allergies-that to alcohol and that to pollens-are comparable in
their effects. Everyone is familiar with the symptoms of hay fever-the
irritation of the throat and nasal passages producing running of the nose
and weeping from the eyes. The allergic reaction to alcohol is an
irritation of the cells of the brain, causing them to weep. Under this
brain edema-the brain now having from ten to fifteen times more fluid
than it should have one or two drinks of alcohol are sufficient to set
the patient off. He finds himself without the ability to stop drinking.
Whereas formerly this person could take from ten to fifteen drinks with
mild effect, now one drink effects a change in his personality.
A person whose brain chemistry is in this state has become a chronic
alcoholic.
With the increase of edema, there is a corresponding disintegration of
the personality. Cunning trickery takes the place of frankness. The
alcoholic's sexual life becomes promiscuous. His ethical values are
disordered. He is wholly untrustworthy. Any oath given is worthless. He
forges checks. He is peevish, sullen, harsh in manner, vulgar in
speech-in total contrast to his normal reaction to life. He is, in fact,
a Dr. Jekyll and Mr. Hyde.
This change in personality is the result of the pressure of the fluid in
the brain on the higher centers of the cortex. The best part of the
man-the last to develop evolutionally-is always the first to be affected
by alcohol.
Contrary to general belief as to its effects on the nervous system,
alcohol is not a stimulant. Its normal physiological action is sedative.
At all times, it has a narcotic effect on the highest controlling centers
of the brain. This leads to a release from control in the lower levels,
bringing about a brisk flow of ideas with speech, action, and
self-confidence.
Many men and some women drink to get this effect.
Alcohol seems to set them free from something. Actually, what happens
when the higher centers of the brain are paralyzed by alcohol is a marked
diminution of self-criticism; the power of deliberation and careful
judgment are overthrown.
As more alcohol is taken into the system, the deeper centers are
affected. We notice a further lessening of self- criticism, manifested by
inflamed emotions, excited talk, aggressiveness, and fine sensory-motor
disturbances, as exhibited in difficulties of speech and clumsiness in
movements.
In the chronic alcoholic whose intracranial pressure is far above normal,
these effects happen very swiftly. He is drunk with the first drink. And
one drink may send him on a week's debauch. He may know that he will lose
his job by going on a week's bout, and his family may be wholly dependent
on him; yet he will sacrifice his all for this drunken spree. Once
started, no one can stop him.
When he comes off the spree, he is full of excuses. He blames everybody
in the world but himself. His wife has said the wrong word; his boss was
unjust; he lost a client, or he dropped some money in the market, or he
ran into some old college friends. . . . He possesses a million excuses.
Whatever excuse he gives and may believe in, the reason for his drinking
is found in his brain chemistry.
Such men do not crave alcohol because they are weak characters. They are
sick. Though they may not have had any alcohol for months, the
intracranial-fluid pressure makes them emotionally unstable. Because of
this instability, which is felt as a bewildered unease, the most
strong-willed individual surrenders finally and reaches for "one drink."
He tells himself that this will steady him.
The chronic alcoholic gets, as he thinks, relief from emotional and
nervous instability because even one drink now gives him a measure of
unself-consciousness. He becomes almost instantly irresponsible, but he
is not aware of it. His condition is such that one drink mounts to his
brain, excites the chronically disturbed cells there, and increases the
intracranial pressure. This pressure upon the brain and nervous system
makes him a different man.
It is useless to plead with an individual who is in this condition to use
his will power. He cannot.
Chronic Alcoholism Can Be Cured
There have been many apparent, temporary successes in "cure" through
religious cults, a love affair, or psychoanalysis. In such cases,
however, abstinence has not indicated will power against drink, nor is
there any removal of the cause of emotional instability. In such cases,
emotional debauches have been substituted for alcoholic debauches. While
their intensity lasts, an alcoholic may be able to keep from drinking.
But none of these cures relieves the intracranial fluid pressure or
changes the brain chemistry. The allergic reaction is still there in the
cells.
If you take the intracranial pressure of these alcoholics-even when they
have been entirely sober for a long period of time-you will find it from
ten to fifteen times above the normal. Examination of the spinal fluid
will reveal an increase of globulin and an increase of albumin, producing
a protein reaction.
When you get these results from the tests, you may be sure that you have
a chronic alcoholic to treat. Until you reduce the intracranial pressure
to normal and the spinal- fluid chemistry to normal, there is no possible
hope that this patient will not drink again.
The treatment is done by a series of lumbar punctures, ten days apart,
and by allied medical treatment. At each puncture, an amount of the
spinal fluid is drawn off. This is examined to check the chemistry as the
treatment goes on. With each puncture, the pressure is taken.
By drawing off the fluid at predetermined rates, depending on the
conditions found, the brain pressure can be reduced. The patient then is
medically treated so that the superexcited cells of the brain covering
are healed. This simple and harmless operation corrects the edema of the
brain.
The operation can be done in the physician's office without
hospitalization, if the patient's condition is not dangerous. The
treatment does not require that a man who is capable of working shall
give up his business or job. He can stop in at the doctor's office, have
the puncture made, his pressure taken, rest half an hour, and go back to
his office desk. In cases in which the patient is exhausted by drinking
or has some organic weakness, hospitalization for the first few weeks is
recommended.
How the Cure Works
After the first lumbar puncture, relieving the pressure on the brain
somewhat, the patient usually loses the desire for drink. Many patients
report that the sight and the smell of alcohol become repugnant to them.
No effort is required to keep from drinking.
As the treatment proceeds, all the irritation of the brain cells is
gradually removed. The pressure becomes normal. The globulin, albumin,
and sugar in the spinal fluid show as normal. When this condition has
been brought about, you may be sure that the patient has, and will have,
no impulse to drink.
Parallel with these changes in the brain chemistry go the changes in the
patient's personality. After the second lumbar puncture, the patient will
usually tell you of the obsessions that have grown up in his mind as a
result of his alcoholic debauches. Most of these fears, apprehensions,
and jealousies disappear as the spinal fluid is drawn off and as the
chemistry changes back to normal. Those that do not disappear should be
discussed with the patient along the lines already indicated in
discussing the various neuroses.
It is highly important that the patient shall understand all about his
condition, all the facts concerning his brain chemistry and the
spinal-fluid pressure as each puncture is made. There should be no
mystery connected with the treatment. Complete and intelligent
understanding is the first step toward his getting well.
By the time the fourth or fifth lumbar puncture is made, the patient's
personality will have changed back to its normal state. The craftiness
will have disappeared completely. His love and tender regard for his wife
and his children will have returned. He will be trustworthy once again.
All the petty reactions of irritation disappear. The man is no longer
irresponsible toward life and work.
As these patients go on in life, you are particularly struck by the fine
quality of their mental and emotional balance. The personality is
integrated and stabilized. They are able to carry their loads without
breaking down under them.
An Alcoholic's "Pilgrim's Progress"
One man tells the following case history:
"An alcoholic's Pilgrim's Progress from the depths of sodden drunkenness
to the heights of sobriety may be likened to Bunyan's hero's surveying
from the Celestial City his toilsome path through the slough of
despondency and the other hazards of the great classic. Looking backward,
it seems unreal or allegorical.
"Starting in the usual social way, liquor gradually got hold of me, until
by 1924 I was a confirmed alcoholic. Sprees of two and three weeks'
duration became frequent. I had attained to a good income and excellent
standing in the legal profession, but alcohol forced me to resign from my
firm.
"This sobered me for a while. But when I was faced with difficulty again,
I sought relief in alcohol.
"Then followed trips to sanatoria, health farms, and as I went lower,
three trips to the alcoholic ward at Bellevue Hospital, New York. There
were numerous similar trips to the Jersey City Hospital and voluntary
commitment to the New Jersey State hospital at Greystone Park. All
without permanent result.
"By November, 1933, I was in the gutter.
"That was my final 'bender.' A friend had read of the method of treating
chronic alcoholism by a reduction of the intracranial pressure through
lumbar punctures. She persuaded me to try the treatment.
"The first puncture showed my intracranial pressure to be forty- eight.
(I believe six is considered normal.) The doctor told me that unless the
pressure was reduced I was headed for insanity. Treatments and punctures
followed at regular intervals, and the pressure was finally reduced to
around twelve.
"The bare recital of the treatment and its result does not be. gin to
illustrate the inner change wrought in my brain and personality. During
my drinking spells and in the remorse that followed each of these, my
relatives and friends had besought me to use my will power. I needed no
beseeching. No one could lecture me as well as I could lecture myself on
the dire necessity of mastering the habit. I would try and try. But
always the first drink started me on the road to insensibility and
stupor. All that was needed was one drink and a cigarette.
"After the first lumbar puncture, however, the change in me was quite
apparent to my friends and myself. There seemed to be something for my
will to work upon. I found it easy to resist the craving. Gradually, as
the treatment progressed, alcohol seemed no longer an indispensable part
of my life. I ceased to think of it at all. In the end, my long years of
sprees and drunk enness seemed almost unreal-as if they had happened to
another man, not to me.
"Then began the attempt to make a comeback in my profes. sign. I started
anew at the very bottom in a minor position. While the going has been
tough, especially in these days of chronic depression for lawyers, I have
at last got a foothold.
"I have no difficulty in refusing proffered liquor. An amusing experience
proved this to me in 1936. I was in a Southern city with a group of
lawyers and returned with them from court after a victory. They all
started drinking in celebration, but I had no difficulty in abstaining.
When a telephone call came from an official of the client, I was the only
one in the crowd who could be trusted to answer the call.
"I am firmly convinced by my own experience that in certain individuals
like myself the continued use of alcohol sets up in the brain a
pathological change evidenced by increased intracranial pressure. It is
idle to expect the individual to exert his will power to resist the
craving until that pressure is reduced. I know that the lumbar punctures
effect that reduction.
"I have had no ill effects from the punctures. On the contrary, my
general health is greatly improved. I know my mind is keener since I came
out of the alcoholic fog eight years ago. I live in Washington, D. C.,
and in the early days of the New Deal, after my cure, I passed a
civil-sernce examination for senior attorney with a rating of 100 per
cent, including 5 per cent veteran's preference. The eligible list was
never used by the government, because the political incumbents who, under
the law, were to be displaced were blanketed into their jobs by executive
order. But the examination, costing thousands of dollars for thousands of
applicants, served a highly useful purpose to me-it demonstrated that I
had come back mentally. And all the way...."
Why People Drink
Far and away the largest number of people who drink do so for purely
social reasons and with no ill effects at the time or later. No one but a
rabid prohibitionist can raise any reasonable objections to anyone's
taking one or two or more drinks, when these do not bring about a change
in the personality. It is only when the man or the woman becomes maudlin,
amorous, or quarrelsome that we are disgusted. It is at the point at
which alcohol changes the personality that the logical objection to it
begins.
When the drinker is a chronic alcoholic and goes too far, brain-cell
changes take place, patches of cells die. When these changes take place,
the damage is beyond correction and beyond repair. However, chronic
alcoholism need not reach that stage, now that we have this new treatment
for it.
In the event that a lumbar puncture and examination of the spinal fluid
do reveal the allergic condition, then this condition should be relieved
and cleared up before treating the fear neurosis. The theory we work on
is always to treat the organic disorder before proceeding to the
treatment of the mental disorder.
Of course, it must not be overlooked that a person who starts drinking to
steady himself against his own fear may become a chronic alcoholic. If he
happens to have the brain chemistry out of which chronic alcoholics are
made, drinking acts upon him like dropping a lighted match into a barrel
of gasoline. His brain chemistry may be such that a small amount of
drinking will put him in the chronic alcoholic group. On the other hand,
he may drink heavily for years before the chemical change occurs.
The treatment for a fear neurosis that involves alcohol is no different
in theory from the treatment for a case of mysophobia. It follows along
the same lines that have been described fully in previous chapters of
this book.
Are Lumbar Punctures Dangerous?
No, they are not dangerous in the least. We do them commonly in testing
for syphilis and for various brain diseases. In fact, any complete
examination today includes a lumbar puncture and an analysis of the
spinal fluid.
It is true that many physicians, through ignorance, do not want to do
lumbar punctures and will tell their patients that this is a dangerous
and doubtful operation.
It is done in a few minutes, without anesthetic, and the patient
experiences no pain except that felt when the needle pierces the skin. He
may have a slight headache afterward, but there are no other effects if
he is not already in an exhausted state.
I was the first medical man in the world to do a lumbar puncture for
chronic alcoholism and the first to do lumbar punctures in the treatment
of delirium tremens. That was in 1909. Since then I have worked out the
treatment for these cases, and this treatment is carried on by many
physicians everywhere in the world. I am convinced that the only way to
put a chronic alcoholic back where he was before alcohol "got" him and
altered his brain chemistry is by reducing the intracranial-fluid
pressure, thereby lessening the emotional tension and reducing his
feeling of inward insecurity. The treatment I have described will do
this. It will bring the patient's brain chemistry back to normal. It is
the only method I know that will do this.
To Remember
1. Chronic alcoholism is not a sin. It is a brain chemistry disease.
2. Moral suasion, psychoanalysis, and religious conversions cannot
alter the facts of the brain chemistry any more than they can cure
tuberculosis.
3. Lumbar punctures that reduce the fluid pressure on the brain are the
only means that will change the brain chemistry and give the patient
the chance of a scientific cure.
Contact:
The Legacy Group of Alcoholics Anonymous © 2005