What You Can Change _. And What You Can't - Martin E. Seligman [106]
Before I report what he found, I want to mention his second study, whose subjects came from the opposite end of the American spectrum of opportunity: Boston’s inner city. These men, too, were followed for forty years. Seventy-one of them became alcoholic; 260 did not. Again, Vaillant asked how the alcoholics differed from the rest before their alcoholism.
The results of the two studies were identical. There is no sign of an alcoholic personality. The men who became alcoholics differed in only two ways from the men who did not: They had more alcoholic relatives and they were more likely to be Northern European (particularly Irish). Emotional insecurity, depression, dependence, criminality while young, and the rest of the addictive panoply (in the absence of alcoholic parents) did not predict alcoholism.7
These results are a breath of fresh air. Before Vaillant’s discovery, clinicians who looked at alcoholics only during the disease felt free to make such alarmist pronouncements as “The development of the disease process of alcoholism is inconceivable without underlying psychopathology.”8 Vaillant’s discovery is that such pronouncements are simply wrong: It is alcoholism that produces the traits of depression, dependence, criminality, and so on. The only thing alcoholics have in common prior to their alcoholism is a dangerous susceptibility to alcohol, not underlying bad character or mental illness that merely displays itself in the guise of drunkenness.
The good news is that once alcohol abuse ends, so do these undesirable traits. The recovered alcoholic is no more depressive, psychopathic, pessimistic, or selfish than any of the rest of us. Since he may have missed two decades of his life, however, he is often less grown up in work, in emotional life, and in relationships than other men his age. As my closest childhood friend told me after recovering from twenty-five years of drug abuse, “Marty, I’m fifty going on twenty-five.”
Is Alcoholism Progressive?
It is a central tenet of AA that alcoholism is not only a disease but a progressive disease. Like syphilis, which unchecked progresses from a sore on the penis to weakness of the limbs to insanity to death, alcoholism unchecked progresses from social tippling to abuse to addiction to death. Once someone genetically inclined to be alcoholic starts abusing alcohol, there can be only one of two outcomes: death from alcoholism or total abstinence. Is this picture true?
There is one sense in which alcoholism is certainly progressive. Alcohol produces tolerance—you need more and more of it to give you the same high. Tolerance, along with withdrawal—the craving that abstinence produces—is what it means to have an addiction. When someone claims that alcohol or heroin produces a physical addiction, they are wrong if they believe that there is some known chemical or biological pathology. Rather, “physical” addiction is a misnomer. All it refers to are behavioral facts: It takes more and more of the substance to work, and if you stop taking it, you will suffer withdrawal.9
But needing more and more alcohol is not what AA means by the claim that alcoholism is progressive. This claim means that the symptoms get worse with more alcohol. First come blackouts and frequent intoxication, then arrests, complaints from friends and relatives, and morning drinking. This is followed by repeated failures to stop drinking. Then come job loss and benders. Finally, after three to ten years, come convulsions, hospital treatment, and AA. This ends either with successful abstinence or with death.10
The same landmark study that answered the question of whether there is an addictive personality tells us whether alcoholism is progressive. Because the study provides an entire lifetime picture of the alcoholic—before, during, and after (if there is an after)—it