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January 1973

From AA members and other alcoholics, I have learned many lessons. Many other physicians who have listened with open minds have learned the same facts. But before I pass those lessons on to you, let me first, in the AA fashion, share my experience—and hopes—with you.

Some years ago, I found out that a member of my husband’s family had developed alcoholism, and I was horrified that no branch of medical science seemed able at that time to do much about it. Some of the drying-out misery could be eased occasionally, but no kind of medical treatment produced long-lasting sobriety.

And then, about 33 years ago, I heard my first AA speaker, Marty M. It changed my entire life and I shall always be grateful. I began to devote all my professional energies to helping alcoholics, and I tried to get every alcoholic I saw into AA. I still do.

In the first flush of my enthusiasm, I am sure I made many mistakes—like any AA newcomer, I guess. Often, I found myself carrying the patient, rather than carrying the message of recovery to the patient. But I learned better. And eventually, in order to do a better job with alcoholics, I went back into training and became a psychiatrist and psychoanalyst.

After a few years, I gave up psychoanalysis as a technique for treating alcoholism. I still think it can be useful for some alcoholics, after they have established some stable AA sobriety. But from my own experience, I have seen that simply understanding your problems certainly cannot turn any alcoholic into a social drinker! To quote an alcoholic psychiatrist and psychoanalyst who was once a patient of mine: “One martini, and all your insight goes right out the window!” He had had 17 years of psychoanalysis, but his drinking just kept getting worse.

As time went on, I learned that many alcoholics simply will not go to AA, as AA members know all too well. Moreover, some who go to AA may seem just as sincere as others and may seem to try just as hard as they can, but they do not seem to be able to stay sober. My AA friends tell me they meet alcoholics like this, too.

Pretty soon, I saw that I could probably get most of my patients into AA somehow, and they would recover. But what about those others—those who would not go near AA or seemed unwilling or unable to grasp the AA philosophy? Should I turn them away to die, or keep trying to find something that would help them, at least to some degree?

I decided to keep “pushing” AA as the cornerstone of my treatment, but also to keep on trying to find other kinds of help for the alcoholics unaffected by AA.

Aiming for an open-minded attitude, I began investigating all kinds of treatments for alcoholics. Among those I tried, but discarded, were LSD, hypnotherapy, psychoanalytically-oriented group therapy, megavitamin therapy, and encounter groups. All of these, when properly used by good therapists on properly selected patients, have helped some alcoholics, I know. But for my own practice, better results are achieved otherwise.

Now, supplementing a strongly prescribed big dose of AA, I use primarily counseling, Antabuse, psychodrama, and informational therapy—that is, simply teaching alcoholics facts and removing some of their old misinformation about alcohol and alcoholism.

Four questions I am still asked frequently, and some brief answers, are:

1. What about tranquilizers and sedatives for alcoholics?

Given in a hospital during withdrawal under proper medical safeguards, these can be useful. But they are highly addictive, and alcoholics need to learn to live without any mood-changing chemicals. I wish all physicians would quit liberally handing out prescriptions of these drugs to almost all patients, and certainly quit prescribing them for alcoholics.

2. What about so-called cures and returns to “normal” drinking?

The alcoholic can no more go back to “normal” drinking than a pickle can go back to being a cucumber. We must not overlook the pharmacological side of alcoholism. Physiologically, the addiction is irreversible, and the condition gets more serious as age progresses.

There have been, in medical history, one or two genuine, well documented exceptions, just as there have been a few unexplained, spontaneous cures of cancer. But neither the doctor nor the patient is well advised to bank on such an apparent miracle. I have never seen one myself. The alcoholics I have known who went back to drinking wound up in worse shape than ever. None has been able to do “normal” drinking, and the odds must be something like two million to one against it.

But what is so extraordinarily marvelous about “normal” drinking, anyhow? When people have learned to lead full lives without alcohol, cigarettes, or any other drugs, why go back to them?

3. What about Antabuse?

It can be a very useful aid in helping to establish a period of no drinking for many alcoholics, but not all alcoholics should take it. It certainly is not the whole answer to alcoholism. The sobriety period which Antabuse helps to produce should be used to get a good grasp of AA, in my opinion, and then the Antabuse can be given up.

Incidentally, Antabuse is not a mood-changing drug. It has no physiological effect whatsoever—even if taken for many years—as long as the patient avoids all alcohol in any form.

4. How does AA rank in your opinion now?

It is the very best. I am also very enthusiastic about the Al-Anon Family Groups and Alateen. These two fellowships can do wonderful things that no one else can. Without them, too often those of us trying to help the alcoholic become the “enablers” or the “co-alcoholics,” who just make the situation worse without meaning to or knowing it.

I am excited by the prospect of new genetic and biochemical discoveries, as well as the new understanding we are now beginning to have of the brain.

But as far as I can see, it looks to me as if AA has about the rosiest future of all, if you will just keep on carrying your message, with an open mind.

Ruth Fox, MD