The ultimate solution to addiction
Let me put some of my cards on the table. I turn 65 on Christmas Day. And if I survive until Australia Day 2010 I will have had no alcohol or other drugs in the last 40 years. This means I’ve had 40 more years on the planet than I otherwise would have had.
Like a lot of teenagers who are prone to addiction, I got into trouble with alcohol at an early age – in fact from my first drink of alcohol at age fourteen I drank in a manner that was out of control.
Despite all the advances in medicine and in the so-called “helping professions”, few experts understand that a significant number of teenagers who drink alcohol, no matter what their level of education, ethnicity or gender, will end up becoming alcohol-dependent. And for those who become alcoholic, however young, the only safe solution is not to drink at all – otherwise the end result may eventually be severe physical and mental impairment or death.
It is important to stress that alcoholism is a health problem, not a moral problem. Alcoholics are not bad people who need to be good, but people suffering from an illness who can recover – if they learn to totally avoid drinking alcohol, one day at a time.
In the twenty-first century, one disturbing trend is an exponential increase, among Australians aged 16 to 24, in out-of-control drinking, and especially of binge drinking in teenage girls.
This problem is accentuated if, as so often happens, teenagers use other drugs including ecstasy, ice, cocaine, and especially marijuana, which is cultivated hydroponically and is therefore so much stronger than it used to be 20 or 30 years ago.
In spite of abstinence having saved the lives of countless people, not drinking alcohol at all is seen by many as being rather weird, especially if one is young. Yet these days, a number of 16, 17 and 18 year old drinkers have done so much physical, emotional and social damage to themselves and others that they are seeking help, including joining groups like Alcoholics Anonymous whose meetings they regularly attend in order to remain abstinent from alcohol and other drugs.
Unfortunately, in our society there is still enormous social and peer-group pressure on those who wish to avoid alcohol. Not surprisingly, this pressure is extremely strong on the young, be it from friends, school or workmates, or from other members of sporting clubs and other organizations to which teenagers may belong.
In a society like ours, with such an entrenched drink culture and with such a politically powerful liquor industry, advertising and significant social and peer group pressure is often applied to those who need to remain abstinent in order to stay alive, let alone to live productive lives. This even applies in our prisons, where 80% of inmates have significant problems with alcohol and other drugs. Of this group, there is a core of about 40% who need to remain totally abstinent if they are not to become recidivists. Yet even within our prison population there is strong pressure, from psychologists and other professionals, to advocate so –called “harm minimisation” and to oppose the notion of total abstinence.
In common (and often professional) usage the notion of “harm minimisation” conflates two separate, and very different, ideas. Only one of these do I support and that is the idea of preventing avoidable harms, for example by providing safe needle exchanges and supervised injecting rooms to prevent users contracting HIV, hepatitis and other preventable disease.
But the second notion of so-called harm minimization I cannot support and that is the notion that alcoholics and addicts can (and should) be taught to somehow “moderate” or “control” their usage, as opposed to try and learn to abstain. And this is despite the fundamental fact that most other drug use in our society is illegal! How bizarre then to be informed by prison psychologists that, while in custody, prisoner X and Y is learning to moderate his or her drug use – as though this was somehow praiseworthy.
In Australia there is still strong pressure exercised against those who don’t drink alcohol. This includes deep suspicion about those who do abstain. As Sir Les Patterson puts it: “Never trust a man who doesn’t drink/ Though he may not throw up on your kitchen sink/ I’d rather be half-hearted/ Than be a blue-nose, wowser bastard/ So NEVER trust a man who doesn’t drink.”
Recently at a party in Redfern I overheard someone say “Watch her, she doesn’t drink!” Indeed at social functions when I drink mineral water or fruit juice I am often asked, “What’s the matter, don’t you drink?” To which I sometimes reply, “What do you think I’m doing, eating a sandwich?”?
Of course I drink. I drink a lot. It’s just that I don’t drink alcohol. This is because, as with about 7 to 8 per cent of the Australian population, one glass containing alcohol is one too many – and a hundred are not enough. The trick for people like me is therefore not to imbibe the first one, and to have nothing in our blood but blood.
Although not always the case, quite often a propensity to alcoholism and other drug addition is genetically based. Speaking personally, my father was a rough, tough footballer who played Aussie Rules for Collingwood, but he never drank a teaspoon full of alcohol in his life. This was because his father was an alcoholic whose drinking blighted his marriage and destroyed the family business.
My first drink of alcohol, at age 14, was at the same place that, up to now, I had my last drink – at Her Majesty’s Hotel in Toorak Road in Melbourne, then run by Maisy, a well-known drag queen. For no other reason than that it seemed exotic, after having visited a local doctor, I fronted the bar in my Melbourne Boys High school uniform at about 11AM and ordered a brandy, lime and soda. The waiter, very kindly, suggested that I take off my school hat!
That first drink of alcohol was like an injection of rocket fuel. Very soon, I was drinking as much as I could, usually on my own. Quite often, my idea of a good Saturday night was to go to the Brighton Cemetery, with a flagon of claret, and sit drinking in front of Adam Lindsay Gordon’s obelisk which reads: “Life is only froth and bubble, Two things stand like stone, Kindness in another’s trouble, Courage in your own.”
I now think it significant that, instead of being attracted to the grave of the gangster Squizzy Taylor or to the bent Victorian politician Sir Thomas Bent, I found myself in front of Gordon, the alcoholic poet, who killed himself on the beach near Park Street Brighton, where when young I often used to drink myself.
When I was 16, I stumbled home drunk from Middle Brighton beach at 2AM. My father, fit, tall and erect, was waiting up for me. “What are you celebrating, son?” he said. I had no answer. I didn’t know that I was drinking because I had to. Then Dad told me something I’ve never forgotten. “When I was your age, son, I lost two bicycles looking for my father.”
It seems to me that my dad knew that he, like his father, was potentially an alcoholic and that’s why he never drank at all. He believed, from experiencing his father’s alcoholism at close hand, that if he started drinking, he’d be putting himself at great risk. He also understood that booze would also get me – his only living child – into terrible trouble. And it did. From the age of 15 to 25 alcohol caused me, and those close to me, enormous damage.
Finally, it dawned that, rather than other people, situations and things being to blame, alcohol was the primary cause of my problems. So, after returning from America, and turning on one last catastrophic drinking session at Maisy’s, in January 1970 I managed to put the cork in the bottle, and, so far, to keep it there. Since then I have been free of all other drugs as well.
I’m pleased to say that I managed to stop drinking three years before my father died, which meant that he and I were able to get to know each other properly, without my drunkenness sullying our relationship.
But despite being almost 40 years sober, I still need to be vigilant. I need to realise that what matters most in my life is that I don’t pick up the first drink of alcohol, one day at a time.
About 20 years ago, I was waiting for my friend, Jim Maclaine, then a psychologist at Sydney’s Langton Clinic, when it was abstinence-oriented. Through the paper-thin walls, I overheard Jim talking to a new patient whose name, I recall, was Boris. Said Jim, “Boris, now that you’ve been admitted to this hospital as an alcoholic, for as long as you live you’ll be spending a lot of your time with other alcoholics. The big question is whether they’re going to be drunken ones or sober ones.”
Jim continued: “If you cross South Dowling Street outside the Clinic, and get run over by a truck and break your hip, depending on your personality if may take three months, it may take six months, it may take a year or even two, but eventually you’ll forget the dreadful pain of breaking your hip and be able to cross a road without a qualm.” That forgetfulness, he explained, is a necessary and important part of human evolution. If we remembered all the dreadful pains of existence we’d never get out of bed. “That forgetfulness is enormously helpful – except for what you’ve got Boris, except for alcoholism. You need to remember organically what has happened to you. The best way that I know of achieving this”, he said, “is to regularly attend meetings of Alcoholics Anonymous and listen to other alcoholics tell what they used to be like, what happened, and what they are like now.”
Alcoholism and drug addiction among the young is much more prevalent than most people in Australia, and many in the media, realise.
If someone, young or old, inquires ‘Am I an alcoholic?’ I suggest they ask themselves four questions:
Most importantly: Is alcohol costing you more than money?
* Does your personality change for the worse after drinking?
* Do your relatives, friends, lovers etc point out that you have a problem with alcohol?
* Sometimes after drinking, do you have hours, or even days, that you cannot remember?
If you answer yes to at least three of these questions you are almost certainly an alcoholic or at the very least a severely impaired problem drinker. And over the long term (i.e. over 2 to 3 years) the only safe option is to aim for total abstinence.
Yet regretfully these days as a therapeutic aim, abstinence is still often regarded with askance.
Thank God for groups like the Salvos who in treating alcoholics and other addicts, still aims for complete abstinence rather than so-called “controlled” drinking or drug use. Indeed in many centres across Australia, the Salvos’ Bridge Program still makes pivotal use of Alcoholics Anonymous, its meetings and its 12 suggested steps of recovery.
The first of AA’s 12 steps says: “We admitted we were powerless over alcohol, that our lives had become unmanageable.” No matter how long they have been sober, alcoholics in the Bridge Program and in AA always speak of their alcoholism in the present tense: “My name is … and I am an alcoholic.” This is because alcoholics and other addicts are never really cured of their alcoholism, in that if they start drinking and using again they are bound, over the long term, to relapse into uncontrolled usage. In order to stay alive and to live useful and meaningful lives, alcoholics and other addicts need to make a daily commitment to a life choice of stable abstinence.
Psychoanalyst Carl Jung, who was instrumental in the founding of AA, explained that the Latin word for alcohol is spiritus and that we use the same term “for the highest religious experience as well as the most depraving poison”. When dealing with alcoholism, said Jung, the most helpful formula is spiritus contra spiritum: spirit against spirit, or power against power. This is why AA suggests that newcomers to the program try to develop a belief in what it calls “a power greater than oneself”.
This notion can apply equally for theists and for non-theists, for agnostics and for atheists. All that is required is the realisation that, like cancer or diabetes, usually alcoholism cannot, over the long term, be vanquished by an isolated exertion of the individual’s will.
To most people it is obvious, given the damaging, life-threatening consequences of alcoholism and other drug addiction, and the proven inability of alcoholics and addicts to control their drinking or drug use, that the goal of treatment should be total abstinence. Yet in the past 30 years in Australia, and elsewhere in the West, an anti-abstinence orthodoxy has become entrenched in health department and corrective services practice and policy, with extremely unfortunate results.
What is particularly damaging is that alcoholics and other addicts and their families are given the false hope that controlled drinking is a viable option and that abstinence is no longer necessary.
Despite the continued advocacy by many state and federal health workers and government bureaucrats for alcoholics to be treated by controlled drinking programs, the evidence is very strong that after three years or more the aim of controlled use fails miserably for people with addictions. Indeed, over the long term, almost all alcoholics who aim for anything other than complete abstinence return to full-blown addiction.
May I draw your attention to the path-breaking work of Professor George Vaillant from Harvard University who has shown that there is compelling long-term evidence that for alcoholics and those addicted to other drugs, moderation and so-called controlled usage does not work.
As Vaillant succinctly puts it in his long-term longitudinal study, ‘The Natural History of Alcoholism Revisited’: “Despite its prominence 20 years ago, training alcohol-dependent individuals to achieve stable return to controlled drinking is a mirage. Hopeful initial reports have not led to replication.”
Initially, in the 1980s, funded by the Rand Foundation Vaillant supported the controlled use of alcohol and other drugs but, after seeing the results of his long-term follow-up studies, he has moved to advocating abstinence and the 12-step approach of Alcoholics Anonymous, which is by far the most successful agency in helping alcoholics and problem drinkers to stop drinking alcohol and to stop using other drugs as well.
Yet because it is an unpaid lay movement of men and women who have managed to stay free of alcohol and wish to help other alcoholics to achieve sobriety, AA is often undervalued or not valued at all by medical practitioners and health professionals.
Despite overwhelming long-term evidence, in Australia the proponents of controlled usage remain in favour with most government bureaucrats and health professionals, while those who advocate a strategy of abstinence are marginalised or ignored. As Vaillant’s comprehensive studies of alcohol abusers clearly demonstrate, while five to six years of abstinence is adequate to predict a stable future, return to controlled drinking is a much less stable state. To put it another way, after abstinence has been maintained for five years, relapse is rare. In contrast, return to controlled drinking without eventual relapse is unlikely.
This is not to deny that even severely dependent individuals can occasionally achieve more moderate drinking; the crucial caveat is that this is a relatively unusual occurrence. Moreover, even staunch control drinking or drug usage advocates acknowledge that a successful outcome becomes less likely as the severity of dependence on alcohol and other drugs increases.
This is not to dispute that alcoholics and addicts are extremely resistant to adopting a goal of abstinence and often strongly deny the assertion that they cannot safely use alcohol or other drugs. Indeed, such resistance and denial are integral parts of their disorder. Theoreticians who advocate controlled usage do so precisely because it is difficult for alcohol-dependent and other drug-dependent people to consider abstinence. But there is no empirical evidence that controlled drinking or drug-usage strategies works for such people for any extended period – that is, three years or more.
Although, superficially, it may seem a useful strategy to health professionals and government bureaucrats, suggesting that alcoholics and addicts should somehow try to learn to control their drug usage is an enormous waste of human and financial resources that causes, if not death, then often irreparable damage. The truth is that an alcoholic’s or an addict’s best change of recovery lies in practising total abstinence.
It is pleasing to report that groups like the Salvation Army have maintained a commitment to total abstinence via the AA program as the prime therapeutic goal for alcoholics and other addicts. Fortunately in the last few years we are also beginning to see a return to the abstinence model by a small but increasing number of psychologists and medical practitioners, and to once again valuing AA as the most effective form of long-term therapy for persons addicted to alcohol.
Although it may be regarded by some as politically incorrect, I am pleased to report that the New South Wales government, under the leadership of then Health Minister, John Della Bosca, has adopted and extended the provisions of the Inebriates Act of 1912, which for decades had not been widely used. Now in New South Wales, at various facilities throughout the state, an increasing number of severely ill alcoholics can be subject to an order forcing them into effective long-term, life-saving treatment for up to twelve months.
As a side benefit this long-term treatment regime means that, apart from those in the grip of addiction, the families of alcoholics and other addicts can be saved from immense despair and desperation and of physical and psychological injury. At the very least, the revamped Inebriates Act may save the lives of thousands of alcoholics and addicts and, in the process, allow enough time for AA and the Bridge Program to do their highly effective work.
Thank you for having me. Are there any questions?
Professor Ross Fitzgerald is a well-known Australian writer and broadcaster. Professor Fitzgerald is a member of the New South Wales Government’s Expert Advisory Group on Alcohol and Drugs, the Administrative Decisions Tribunal, and the NSW State Parole Authority. Ross is Emeritus Professor of History and Politics at Griffith University in Brisbane. Author of 32 books, this year Professor Fitzgerald co-authored ‘Made in Queensland: A New History’, published by University of Queensland Press and ‘Under the Influence, a history of alcohol in Australia’, published by ABC Books. He is married to Lyndal Moor, has a daughter Emily, and lives in Redfern.