What You Can Change _. And What You Can't - Martin E. Seligman [108]
Paradoxically, extreme severity helps recovery as well. When people are very badly threatened—with death, disfigurement, bankruptcy—they are ripe for conversion. Hitting bottom can, unmistakably, be a powerful force for dramatic change and recovery. Having a middling case of alcoholism, being a “heavy drinker,” has the worst outcome. It is not mild enough to make recovery easy and not extreme enough to threaten life, family, and livelihood so shockingly as to jolt you into abstinence. Vaillant’s Harvard men who were moderately alcoholic at forty still are as they enter old age. The mild cases and the extreme cases do better.14
What are the overall chances of recovery from severe alcoholism in the natural course of events? First, one major caveat: The chronic relapses of alcoholism mean that when researchers look for only a short time—say, for six months after any treatment—they will see a rosy picture. Perhaps as many as 65 percent of people treated are on the wagon for this long after treatment. Every alcoholic has gone on the wagon time and again. Trying to give it up and repeatedly failing is part of what it means to be alcoholic. But the real picture starts to emerge after a minimum of eighteen months. Studies that reveal true chances of recovery from alcoholism are the few very long-term studies.
Here are some representative statistics: Of no alcoholic men from the inner city whom George Vaillant followed for their lifetime, 49 (45 percent) became abstinent for at least a year. Of these 49, 21 (19 percent) became securely abstinent—on the wagon for at least three years. Of 100 clinically treated alcoholics Vaillant followed for twelve years after hospital discharge, 25 percent were stably abstinent, 21 percent were uncertain, 3 7 percent were dead, and 17 percent were still alcohol-dependent. Similar percentages emerge from a ten-year follow-up of British alcoholics. So the best estimates I can venture about the long-term chances of recovery from alcoholism are:15
A substantial minority of alcoholics recover.
About one in five will recover completely.
About half will die prematurely or remain alcohol-dependent.
Socially stable alcoholics have about double the chances of recovery.
Very severe and very mild symptoms most suggest recovery.
When Vaillant compared the men who became abstinent with the men who died or remained alcoholic, he found four natural healing factors among those who recovered. First, the abstinent found a substitute dependency to sustain themselves: candy binges, compulsive eating, Librium, prayer and meditation, chain smoking, work, or a hobby. Second, the abstinent men were threatened with painful and disastrous medical consequences: Hemorrhaging, a fractured hip, seizures, and ghastly stomach problems all brought these men face-to-face with physical destruction (painless liver disease was not enough to drive the point home). Third, the men found a source of increased hope: Religious conversion and Alcoholics Anonymous (of which more in a moment) were typical. Finally, the men often found new love relationships, un-scarred by the guilt and the devastation they had already inflicted on their wives. The more of these four healing factors the men were able to incorporate, the better their chances.
It is against this background of a natural healing process that formal treatment must be compared. Sadly, formal treatments work only marginally better than the natural rate of recovery.
Your first impulse, if you have the means, is probably to enter one of the many elaborate inpatient medical-treatment units for alcoholics. These programs are expensive and usually involve a team of helpers. The best ones offer a wide range of services: drying out (detoxification), counseling,