What You Can Change _. And What You Can't - Martin E. Seligman [107]
Here, AA gets it mostly right. Alcoholism is not inevitably progressive, but it usually is. Of the no inner-city alcoholics looked at over forty years, 73 followed a progressive course ending either in abstinence (about half) or extreme abuse and death (the other half). The remaining 3 7 did not show a progressive disease. These men recovered from alcoholism to social drinking or periodic heavy drinking without much in the way of adverse symptoms.
Vaillant has just obtained the fifty-year follow-up of these men. He now paints an even more complete picture: Early in life, alcoholism progresses. Drinking gets heavier and heavier from age 18 to age 30 to age 40. Then it begins to stabilize. Few alcoholics are worse at age 65 than they were at age 45. Middle age, if you manage to live that long, is usually self-correcting. Crime, obesity, schizophrenia, manic-depression, and alcoholism all tend to burn out in middle age. Vaillant states a “One-Third” rule for alcoholism: By age 65, one-third are dead or in awful shape, one-third are abstinent or drinking socially, and one-third are still trying to quit.11
Can you tell in advance if an alcoholic is headed for the progressive course or the rarer nonprogressive course? Those men headed for the progressive disease had the worst symptoms once they started drinking, they smoked more (two packs a day), and they spent more years feeling “out of control” of their drinking (fifteen versus four years).
Recovery
What are your chances of recovering from alcoholism?
Does treatment work?
Does AA work?
These are very difficult questions to answer. I know of no other area of treatment research in which so much money has been spent and so little has been accomplished. To my mind, the lack of knowledge is a scandal. The right way to determine if treatment X (say, AA or a medication or an inpatient program) works is simple, in principle. Give a group of alcoholics treatment X. Give a control group, matched for factors relevant to recovery (like employment, emotional stability, severity, and social class), everything except treatment X. Then wait and see who shows a better outcome. This has been done for most of the problems we have looked at in this book. It has not been done for alcoholism.
There is one obstacle to good outcome studies of alcoholism: Researchers are dealing with a problem in which a cycle of recovery and relapse is repeated for years in its natural history. Illumination as to why relapse is so common begins with what does not protect you against relapse. George Vaillant, for instance, compared the childhoods of those alcoholics who relapsed time and again with the childhoods of those who became securely abstinent. All of the following do not predict who will become securely abstinent:
good mothering
high boyhood competence
not coming from a multiproblem family
high IQ
good education
no family alcoholism
This should shock those of you who believe in the importance of childhood experience (chapter 14 will shake your belief in this dogma further).
So many factors that seem to protect people against devastation by other psychological troubles fail to protect people against alcoholism because this problem, unlike other diseases, destroys three of the most important factors that facilitate recovery from any disease: ego strength, willpower, and social support. Alcohol damages the brain: Strong people with tenacious willpower are rendered weak and pliant. Alcohol renders “kings and geniuses no different from paupers and imbeciles.” It is the “great leveler of human differences.” Further, alcohol systematically destroys your loves and friendships. It robs you of social support by rendering you selfish, irresponsible, and out of control over anger and sadness. Without friends and family, the sufferers of any chronic disease have a worse course.12
If all these childhood factors fail to make recovery more likely, what succeeds? First, the fewer symptoms you have on the alcoholism quiz, the more likely it