Drunks

by Christopher Finan

  After serving in the South Pacific, Swegan returned home. He was sick with dengue fever and malaria, but he was refused admission to a Veterans Administration hospital because he was an alcoholic. His wife left him and wouldn’t let him visit his daughter. He was unable to hold a job. He tried AA, but he was half the age of the men at the meeting near his hometown in Ohio, and neither he nor they believed he was old enough to be an alcoholic. Out of options, he reenlisted for the security of a warm bed and regular meals and was assigned to Mitchell Air Force Base on Long Island, New York. Swegan began attending AA meetings again in nearby Valley Stream and was finally able to stop drinking in 1948.

  Soon after joining AA, Swegan began thinking about how to carry its message to others. He didn’t have to look far to find alcoholic men and women. “There was an ample enough population of alcoholics in the armed forces. . . . And we were often a real problem to the majority of people around us,” he wrote later. He was already working with several airmen who were hard drinkers when he approached the squadron commander with the idea of giving a speech about alcoholism. The commander “looked at me like my sanity had left me,” Swegan said. Nevertheless, he agreed to the speech.37

  The nervous airman got off to a rough start as he stood before 159 members of his squadron. “I am an alcoholic and have found a way to live a useful life without having to drink alcoholic beverages,” he began.

  The whole room broke out in uproarious laughter on the spot. They knew all about how much I used to drink. . . . I really wanted to just crawl through the floor and disappear. But something different happened than had ever happened to me before in this kind of situation. I squared my shoulders and kept on talking.

  The laughter stopped, and Swegan saw that the men were listening. Later, two quietly asked for help. “In the days that followed, two rapidly became four, and four became six, and six became eight. Something big was off and running, and I had no idea what was going to happen next,” he said.38

  Swegan discovered that his recruits preferred attending AA meetings away from the base, where they did not have to worry about speaking before superior officers. He drove the men to the Valley Stream meeting in his car, until it broke down. The whole enterprise appeared to be at risk until a member of the AA group, Yvelin Gardner, gave him the money to buy another car. Gardner, the deputy director of NCEA, recognized the importance of Swegan’s work and used some of Mann’s many contacts to have Swegan assigned to the chaplain’s office. Swegan, who hadn’t graduated from high school, was also given a scholarship to attend the Yale Summer School of Alcohol Studies to help him prepare for his new career.

  Swegan was so successful with the alcoholics at Mitchell Air Force Base that he worked himself out of a job. In 1953, he was given another chance at Lackland Air Force Base outside San Antonio, Texas. Lackland was a huge facility where all enlisted personnel underwent basic training. With strong support from the chief of psychiatry, Swegan had all the resources he needed to implement a large-scale rehabilitation program. Antipsychotic drugs were prescribed when necessary, and during early recovery, patients could request Antabuse (disulfiram), the nauseant that had become available only a few years earlier. Some patients received psychotherapy in individual or group sessions. Swegan said the most important component of the program was getting patients to regularly attend AA meetings conducted by civilians off the base.

  Swegan believed that the Lackland rehabilitation program was a major breakthrough, and he produced evidence to prove it. He reported the results for the first fifty patients in the American Journal of Psychiatry. Half were sober and successfully performing their duties, based on evaluations provided by their superior officers. Another seven had improved. Swegan estimated that it had cost the air force over a million dollars to train these men, money that would have been wasted if they had been discharged for drinking.

  Swegan took his story of success on the road, traveling to the many air force bases in Texas. He also established relationships at army and navy installations in the area, and many facilities opened rehabilitation programs. In 1954, Swegan was given an opportunity to make the case for providing alcoholism treatment at air force bases worldwide. Although still a sergeant, he traveled to Washington to appear before a committee of high-ranking officers investigating the problem of alcoholism in the air force. The committee members appeared interested, but he learned later that his proposals had been rejected as “too expensive.” Not long afterward, the chief of psychiatry, who had been Swegan’s partner, departed, leaving Swegan without the support he needed to maintain his program. Swegan retired from the air force and took a job running a small alcoholism treatment center. By then, the beginning of a movement to help alcoholics in the workforce was apparent. At least fifty companies had stopped firing employees because they were drunks. A few years later, the first permanent military alcoholism treatment facility was established at the Long Beach Naval Station by Dr. Joseph J. Zuska, a navy captain, and Dick Jewell, a recently retired navy commander who was an AA member.

  By the early 1950s, sober alcoholics had made great progress. AA had grown to over a hundred thousand members, and many were actively engaged in helping others get sober. No one had done more than Marty Mann. On the tenth anniversary of the NCEA in 1954, she listed its accomplishments in a memo to her executive committee. The word “alcoholism” hadn’t even been used in the general press in 1944. Ten years later, “alcoholism [is] now fully and constantly covered in press. Every national magazine has run one or more articles on alcoholism,” she wrote. AA was the only group that supported NCEA in the beginning, but now “interest [is] shown by governmental, professional, and lay groups of all sorts.” Thirty-one states had established alcoholism programs. The NCEA staff had grown to include eight people working in two offices, distributing forty-two educational titles and answering two hundred pieces of correspondence per week.39

  The members of the executive committee knew this was not the full story. Mann’s organization had been experiencing hard times after it separated from the Yale Center of Alcohol Studies in 1950. Renamed the National Committee on Alcoholism, it was having difficulty replacing the funding it had received from Yale. Also questionable was her claim to have achieved “general acceptance of disease concept . . . including AMA, medical societies, some industries, press, large segments of public, State government . . . U.S. Air Force, N.Y.C. Police Force, etc.”40

  Mann was clearly exaggerating when she said the AMA was endorsing the view that alcoholism was a disease. The AMA had approved a definition of “alcoholism,” but that was as far as it was willing to go. There was no agreement on what caused alcoholism. Was it a psychological condition or the manifestation of a physical process that would qualify it as a disease? As late as 1955, Harry Tiebout, Mann’s psychiatrist and a strong supporter of AA, worried about the lack of evidence proving alcoholism was a disease:

  I cannot help but feel that the whole field of alcoholism is way out on a limb which any minute will crack and drop us all in a frightful mess. . . . I sometimes tremble to think of how little we have to back up our claims. We are all skating on thin ice.

  If the disease concept was discredited, the medical treatment of alcoholism might fall with it.41

  But scientists were already engaged in research that would support the argument for treating alcoholism as a disease. Jellinek was perhaps the most influential. He had first entered the alcoholism field when he was hired to conduct a survey of all the existing scientific literature on the subject. After he joined the Yale Center of Alcohol Studies, he began his own research. In 1945, an AA group in New York’s Greenwich Village sent him the results of a questionnaire that it had created and distributed through the AA Grapevine to determine whether AA members shared characteristics of age, home environment, and drinking histories that might be statistically significant enough to draw some conclusions about the nature of alcoholism. Jellinek’s analysis of the data was published in 1946, suggesting the existence o
f phases in the drinking history of alcoholics. He immediately began revising the questionnaire, and a new survey was sent to every AA group with a request that it be distributed to the members. “[O]ne of the chief hopes and expectancies is that the data . . . will provide a new and still more complete set of warning signals by which potential alcoholics will determine how far along the road they have come,” the AA Grapevine said.42

  Two thousand AA members completed the questionnaire, and the new data was published in 1952 by a committee of the World Health Organization (WHO). WHO had established an alcoholism subcommittee of its Expert Committee on Mental Health, and its first act was to recommend that WHO consider classifying alcohol as an addictive drug. Jellinek’s new article, “Phases of Alcohol Addiction,” provided support for such an investigation and presented the strongest evidence to date that alcoholism was a disease by describing in detail a process by which a normal drinker became an alcoholic.

  According to Jellinek, in the pre-alcoholic phase, the incipient drunk was similar to other heavy drinkers, progressing from occasional to constant drinking for relief of anxiety and other personal problems. At the beginning of the second phase, he began to experience blackouts after drinking relatively little. He hid the fact that his drinking was increasing and drank before social engagements where he feared there wouldn’t be enough alcohol. He gulped his first few drinks of the day and began to feel guilty about his drinking. He stopped talking about alcohol and didn’t mention that his blackouts were increasing.

  At the beginning of the “crucial phase,” the path of the alcoholic diverged decisively from that of other heavy drinkers. The heavy drinker might continue drinking for thirty or forty years and consume as much or more than the alcoholic, but he could stop and start at will. At the start of the crucial phase, which began from one year to seven years after the start of heavy drinking, the alcoholic lost the ability to stop drinking once he started and would drink until he was too drunk to continue. “The ‘loss of control’ is a disease condition per se,” Jellinek wrote.43

  The drunk was not completely helpless. Once he was sober again, he could abstain for a time. Then someone offered him a drink, and he got drunk again despite his sincere desire not to. The alcoholic also began to suffer a series of personality changes: he started rationalizing his behavior, first to himself and then to his family, friends, and employer; his self-esteem suffered as he failed again and again to control his drinking, and he compensated with grandiose behavior intended to prove he was a good and important man. He became more aggressive and self-pitying. He was isolated and alone.

  In the final, “chronic phase,” the alcoholic began to drink in the morning and didn’t stop for days at a time. He drank obsessively to obliterate the evidence of impaired thinking, ethical deterioration, indefinable fears, and uncontrollable tremors. He began to experience vague religious desires, but they didn’t last long. His system of rationalization finally collapsed. If he was still breathing, he was ready to admit defeat.

  Jellinek’s article was accompanied by a chart that showed forty-three symptoms that were typical of the four phases of addiction. He emphasized that he was drawing a composite of the average drunk: not every alcoholic experienced every symptom, and the timing of symptoms could differ. Jellinek also acknowledged that he did not know what caused a person to become an alcoholic:

  Whether this . . . process is of a psychopathological nature or whether some physical pathology is involved cannot be stated as yet. . . . Nor is it possible to go beyond conjecture concerning the question whether “loss of control” originates in a predisposing factor (psychological or physical), or whether it is a factor acquired in the course of prolonged excessive drinking.

  The fact that so few excessive drinkers became alcoholics led him to guess that there was “a predisposing X factor in the addictive alcoholic.” Jellinek insisted that not knowing the cause of alcoholism didn’t mean that it wasn’t a disease. In his most significant work, The Disease Concept of Alcoholism, published in 1960, Jellinek concluded, “It comes to this, that a disease is what the medical profession recognizes as such [his italics].”44

  Jellinek’s 1952 article and, later, his book gave scientific legitimacy to the campaign to recognize alcoholism as a disease. Another important step in the process was the growth of support within the medical community. One of the early leaders was Milton G. Potter, an alcoholic doctor in Buffalo, New York, who got sober in 1945 or 1946. In 1947, he founded an NCEA affiliate and persuaded the Erie County Medical Society to establish a special committee on alcoholism.

  Potter also became reacquainted with a classmate from medical school, Marvin Block, another Buffalo doctor. Potter helped Block treat an alcoholic patient and persuaded him to join his alcoholism committee. The two men then persuaded the state medical society and twenty-one county societies to create alcoholism committees. The AMA was unmoved. It rejected a resolution urging the formation of an alcoholism committee twice in 1950. The AMA did create a subcommittee on alcoholism the following year, naming Potter as chair. But it never met because of a lack of funding.

  Finally, in 1954, the AMA created a functioning subcommittee that included Block and Selden Bacon of the Center of Alcohol Studies. By then, Block was treating alcoholics exclusively, and he and Bacon developed a long list of objectives for the committee. They decided that the one most likely to win approval was a “Resolution on Hospitalization of Patients with Alcoholism.” “[A]lcoholism must be regarded within the purview of medical practice,” it declared, adding:

  The Council on Mental Health, its Committee on Alcoholism, and the profession in general recognizes this syndrome of alcoholism as an illness which justifiably should have the attention of physicians.

  The resolution was unanimously adopted by the AMA House of Delegates at a meeting in September 1956.

  The AMA resolution did not use the word “disease,” but Mann and the burgeoning alcoholism movement eagerly claimed it as a vindication of the disease concept. It was also a turning point for the medical community as a whole. Block immediately began pushing for a similar statement by the American Hospital Association, which issued it a year later. After the Journal of the American Medical Association published the AMA resolution, it followed up with articles by Block, Bacon, and other members of the Committee on Alcoholism. In 1957, Block persuaded the AMA to distribute the articles in an official publication, Manual on Alcoholism.

  Harold E. Hughes, a thirty-year-old Iowa truck driver, hit bottom in the same year that Jellinek published “The Phases of Alcohol Addiction.” Alcohol had been causing him trouble for many years. He was six feet two and powerfully built, weighing 220 pounds. He had been a member of an all-state high school football team. During the war, he carried a heavy machine gun into battles in North Africa and Italy. He was frequently involved in drunken brawls and was eventually court-martialed for striking an officer. His drinking worsened after his return to his hometown of Ida Grove, and his family started proceedings to have him committed to a state insane asylum. He escaped confinement by promising to stay sober but started drinking again after fourteen months. Feeling hopeless, he took a shotgun into the bathroom of his home and lay down in the tub with the muzzle of the gun in his mouth, touching the trigger with his thumb.

  Hughes paused long enough to decide that he owed God an explanation for his suicide. Kneeling by the tub, he began to pray. He broke down in tears and was lying on the floor when he became aware of a new emotion. “A warm peace seemed to settle deep within me, filling the terrible emptiness, driving out the self-hate and condemnation,” Hughes wrote in his autobiography. Although he had been raised in the Methodist Church, Hughes had never felt a personal relationship with God. Now he had found “[a] God Who Cared, a God Who loved me. . . . Kneeling on the bathroom floor, I gave Him myself totally. ‘Whatever You ask me to do, Father,’ I cried through hot tears, ‘I will do it.’”45

  Hughes had wanted no part of AA when he first heard about
it. A friend who was a member had invited him to a meeting during the period he was in danger of being committed. Hughes thought he was doing fine on his own. He only considered AA again after he tried to rescue a drunken friend from Florida and ended up drinking himself. He went to his first meeting in a nearby town with another friend, began attending regularly, and established a group in Ida Grove. Once Hughes’s sobriety was firmly established, his career took off. He rose from driving a truck to managing a trucking company. He established an association that represented the interest of small truckers and won election to the Iowa Commerce Commission, which he eventually chaired. A columnist for the Des Moines Register called him “the most telling and moving orator I’ve ever heard.” A Democrat in a Republican state, Hughes was elected governor in 1962. Among his first guests at the state capitol were members of the small AA group in Ida Grove, who had joked about the day they would hold an AA meeting in the governor’s mansion.46

  The state of Iowa had a commission on alcoholism by the time Hughes took office. Three-quarters of the states had created something similar, often locating a new division within the mental health department. This was a necessary first step, which involved educating state legislatures about the nature of alcoholism, and it provided support for the view that alcoholism was a medical problem that seriously affected public health. But the Salvation Army was still the largest provider of services to alcoholics in 1961. Most states lacked the money for treatment and rehabilitation.

  Hughes encouraged the alcoholism commission to apply for a federal demonstration grant to fund an Iowa Comprehensive Alcoholism Program. The grant made it possible to open the first detoxification center in Des Moines and to improve coordination among government agencies, ensuring that alcoholics got access to the same services as other citizens. Iowa also created some of the first halfway houses, giving recovering alcoholics a place to live until they could get on their feet. Hughes insisted that the state government hire sober alcoholics and appointed one to the alcoholism commission.