We believe, and so suggested a few years ago, that the action of alcohol on these chronic alcoholics is a manifestation of an allergy; that the phenomenon of craving is limited to this class and never occurs in the average temperate drinker. These allergic types can never safely use alcohol in any form at all; and once having formed the habit and found they cannot break it, once having lost their self-confidence, their reliance upon things human, their problems pile up on them and become astonishingly difficult to solve.

Frothy emotional appeal seldom suffices. The message which can interest and hold these alcoholic people must have depth and weight. In nearly all cases, their ideals must be grounded in a power greater than themselves, if they are to re-create their lives.

Men and women drink essentially because they like the effect produced by alcohol. The sensation is so elusive that, while they admit it is injurious, they cannot after a time differentiate the true from the false. To them, their alcoholic life seems the only normal one. They are restless, irritable and discontented, unless they can again experience the sense of ease and comfort which comes at once by taking a few drinks-drinks which they see others taking with impunity. After they have succumbed to the desire again, as so many do, and the phenomenon of craving develops, they pass through the well-known stages of a spree, emerging remorseful, with a firm resolution not to drink again. This is repeated over and over, and unless this person can experience an entire psychic change there is very little hope of his recovery.

On the other hand-and strange as this may seem to those who do not understand-once a psychic change has occurred, the very same person who seemed doomed, who had so many problems he despaired of ever solving them, suddenly finds himself easily able to control his desire for alcohol, the only effort necessary being that required to follow a few simple rules.

Men have cried out to me in sincere and despairing appeal: "Doctor, I cannot go on like this! I have everything to live for! I must stop, but I cannot! You must help me!"

Faced with this problem, if a doctor is honest with himself, he must sometimes feel his own inadequacy. Although he gives all that is in him, it often is not enough. One feels that something more than human power is needed to produce the essential psychic change. Though the aggregate of recoveries resulting from psychiatric effort is considerable, we physicians must admit we have made little impression upon the problem as a whole. Many types do not respond to the ordinary psychological approach.

I do not hold with those who believe that alcoholism is entirely a problem of mental control. I have had many men who had, for example, worked a period of months on some problem or business deal which was to be settled on a certain date, favorably to them. They took a drink a day or so prior to the date, and then the phenomenon of craving at once became paramount to all other interests so that the important appointment was not met. These men were not drinking to escape; they were drinking to overcome a craving beyond their mental control.

There are many situations which arise out of the phenomenon of craving which cause men to make the supreme sacrifice rather than continue to fight.

The classification of alcoholics seems most difficult, and in much detail is outside the scope of this book. There are, of course, the psychopaths who are emotionally unstable. We are all familiar with this type. They are always "going on the wagon for keeps." They are over-remorseful and make many resolutions, but never a decision.

There is the type of man who is unwilling to admit that he cannot take a drink. He plans various ways of drinking. He changes his brand or his environment. There is the type who always believes that after being entirely free from alcohol for a period of time he can take a drink without danger. There is the manic-depressive type, who is, perhaps, the least understood by his friends, and about whom a whole chapter could be written.

Then there are types entirely normal in every respect except in the effect alcohol has upon them. They are often able, intelligent, friendly people.

All these, and many others, have one symptom in common: they cannot start drinking without developing the phenomenon of craving. This phenomenon, as we have suggested, may be the manifestation of an allergy which differentiates these people, and sets them apart as a distinct entity. It has never been, by any treatment with which we are familiar, permanently eradicated. The only relief we have to suggest is entire abstinence.

This immediately precipitates us into a seething cauldron of debate. Much has been written pro and con, but among physicians, the general opinion seems to be that most chronic alcoholics are doomed.

It is the purpose of this book to answer such questions specifically. We shall tell you what we have done. Before going into a detailed discussion, it may be well to summarize some points as we see them.

How many time people have said to us: "I can take it or leave it alone. Why can't he?" "Why don't you drink like a gentleman or quit?" "That fellow can't handle his liquor." "Why don't you try beer and wine?" "Lay off the hard stuff." "His will power must be weak." "He could stop if he wanted to." "She's such a sweet girl, I should think he'd stop for her sake." "The doctor told him that if he ever drank again it would kill him, but there he is all lit up again."

Now these are commonplace observations on drinkers which we hear all the time. Back of them is a world of ignorance and misunderstanding. We see that these expressions refer to people whose reactions are very different from ours.

Moderate drinkers have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone.

Then we have a certain type of hard drinker. He may have the habit badly enough to gradually impair him physically and mentally. It may cause him to die a few years before his time. If a sufficiently strong reason ill health, falling in love, change of environment, or the warning of a doctor becomes operative, this man can also stop or moderate, although he may find it difficult and troublesome and may even need medical attention.

But what about the real alcoholic? He may start off as a moderate drinker; he may or may not become a continuous hard drinker; but at some stage of his drinking career he begins to lose all control of his liquor consumption, once he starts to drink.

Here is a fellow who has been puzzling you, especially in his lack of control. He does absurd, incredible, tragic things while drinking. He is a real Dr. Jekyll and Mr. Hyde. He is seldom mildly intoxicated. He is always more or less insanely drunk. His disposition while drinking resembles his normal nature but little. He may be one of the finest fellows in the world. Yet let him drink for a day, and he frequently becomes disgustingly, and even dangerously anti-social. He has a positive genius for getting tight at exactly the wrong moment, particularly when some important decision must be made or engagement kept. He is often perfectly sensible and well balanced concerning everything except liquor, but in that respect he is incredibly dishonest and selfish. He often possesses special abilities, skills, and aptitudes, and has a promising career ahead of him. He uses his gifts to build up a bright outlook for his family and himself, and then pulls the structure down on his head by a senseless series of sprees. He is the fellow who goes to bed so intoxicated he ought to sleep the clock around. Yet early next morning he searches madly for the bottle he misplace the night before. If he can afford it, he may have liquor concealed all over his house to be certain no one gets his entire supply away from him to throw down the wastepipe. As matters grow worse, he begins to use a combination of high-powered sedative and liquor to quiet his nerves so he can go to work. Then comes the day when he simply cannot make it and gets drunk all over again. Perhaps he goes to a doctor who gives him morphine or some sedative with which to taper off. Then he begins to appear at hospitals and sanitariums.

This is by no means a comprehensive picture of the true alcoholic, as our behavior patterns vary. But this description should identify him roughly.

Why does he behave like this? If hundreds of experiences have shown him that one drink means another debacle with all its attendant suffering and humiliation, why is it he takes that one drink? Why can't he stay on the water wagon? What has become of the common sense and will power that he still sometimes displays with respect to other matters?

Perhaps there never will be a full answer to these questions. Opinions vary considerably as to why the alcoholic reacts differently from normal people. We are not sure why, once a certain point is reached, little can be done for him. We cannot answer the riddle.

We know that while the alcoholic keeps away from drink, as he may do for months or years, he reacts much like other men. We are equally positive that once he takes any alcohol whatever into his system, something happens, both in the bodily and mental sense, which makes it virtually impossible for him to stop. The experience of any alcoholic will abundantly confirm this.

These observations would be academic and pointless if our friend never took the first drink, thereby setting the terrible cycle in motion. Therefore, the main problem of the alcoholic centers in his mind, rather than in his body. If you ask him why he started on that last bender, the chances are he will offer you any one of a hundred alibis. Sometimes these excuses have a certain plausibility, but none of them really makes sense in the light of the havoc an alcoholic's drinking bout creates. They sound like the philosophy of the man who, having a headache, beats himself on the head with a hammer so that he can't feel the ache. If you draw this fallacious reasoning to the attention of an alcoholic, he will laugh it off, or become irritated and refuse to talk.

Once in a while he may tell the truth. And the truth, strange to say, is usually that he has no more idea why he took that first drink than you have. Some drinkers have excuses with which they are satisfied part of the time. But in their hearts they really do not know why they do it. Once this malady has a real hold, they are a baffled lot. There is the obsession that somehow, someday, they will beat the game. But they often suspect they are down for the count.

How true this is, few realize. In a vague way their families and friends sense that these drinkers are abnormal, but everybody hopefully awaits the day when the sufferer will rouse himself from his lethargy and assert his power of will.

The tragic truth is that if the man be a real alcoholic, the happy day may not arrive. He has lost control. At a certain point in the drinking of every alcoholic, he passes into a state where the most powerful desire to stop drinking is of absolutely no avail. This tragic situation has already arrived in practically every case long before it is suspected.

The fact is that most alcoholics, for reasons yet obscure, have lost the power of choice in drink. Our so called will power becomes practically nonexistent. We are unable, at certain times, to bring into our consciousness with sufficient force the memory of the suffering and humiliation of even a week or a month ago. We are without defense against the first drink.

The almost certain consequences that follow taking even a glass of beer do not crowd into the mind to deter us. If these thoughts occur, they are hazy and readily supplanted with the old threadbare idea that this time we shall handle ourselves like other people. There is a complete failure of the kind of defense that keeps one from putting his hand on a hot stove.

The alcoholic may say to himself in the most casual way, "It won't burn me this time, so here's how!" Or perhaps he doesn't think at all. How often have some of us begun to drink in this nonchalant way, and after the third or fourth, pounded on the bar and said to ourselves, "For God's sake, how did I ever get started again?" Only to have that thought supplanted by "Well, I'll stop with the sixth drink." Or "What's the use anyhow?"

When this sort of thinking is fully established in an individual with alcoholic tendencies, he has probably placed himself beyond human aid, and unless locked up, may die or to permanently insane. These stark and ugly facts have been confirmed by legions of alcohoholics throughout history. But for the grace of God, there would have been thousands more convincing demonstrations. So many want to stop but cannot.

If you are as seriously alcoholic as we were, we believe there is no middle-of-the-road solution. We were in a position where life was becoming impossible, and if we had passed into the region from which there is no return through human aid, we had but two alternatives: One was to go on to the bitter end, blotting out the consciousness of our intolerable situation as best we could; and the other, to accept spiritual help. This we did because we honestly wanted to, and were willing to make the effort.

Most of us have been unwilling to admit we were real alcoholics. No person likes to think he is bodily and mentally different from his fellows. Therefore, it is not surprising that our drinking careers have been characterized by countless vain attempts to prove we could drink like other people. The idea that somehow, someday he will control and enjoy his drinking is the great obsession of every abnormal drinker. The persistence of this illusion is astonishing. Many pursue it into the gates of insanity or death.

We learned that we had to fully concede to our innermost selves that we were alcoholics. This is the first step in recovery. The delusion that we are like other people, or presently may be, has to be smashed.

We alcoholics are men and women who have lost the ability to control our drinking. We know that no real alcoholic ever recovers control. All of us felt at times that we were regaining control, but such intervals usually brief were inevitably followed by still less control, which led in time to pitiful and incomprehensible demoralization. We are convinced to a man that alcoholics of our type are in the grip of a progressive illness. Over any considerable period we get worse, never better.

We are like men who have lost their legs; they never grow new ones. Neither does there appear to be any kind of treatment which will make alcoholics of our kind like other men. We have tried every imaginable remedy. In some instances there has been brief recovery, followed always by a still worse relapse. Physicians who are familiar with alcoholism agree there is no such thing a making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn't done so yet.

Despite all we can say, many who are real alcoholics are not going to believe they are in that class. By every form of self- deception and experimentation, they will try to prove themselves exceptions to the rule, therefore nonalcoholic. If anyone who is showing inability to control his drinking can do the right-about- face and drink like a gentleman, our hats are off to him. Heaven knows, we have tried hard enough and long enough to drink like other people!

Here are some of the methods we have tried: Drinking beer only, limiting the number of drinks, never drinking alone, never drinking in the morning, drinking only at home, never having it in the house, never drinking during business hours, drinking only at parties, switching from scotch to brandy, drinking only natural wines, agreeing to resign if ever drunk on the job, taking a trip, not taking a trip, swearing off forever (with and without a solemn oath), taking more physical exercise, reading inspirational books, going to health farms and sanitariums, accepting voluntary commitment to asylums we could increase the list ad infinitum.

We do not like to pronounce any individual as alcoholic, but you can quickly diagnose yourself, step over to the nearest barroom and try some controlled drinking. Try to drink and stop abruptly. Try it more than once. It will not take long for you to decide, if you are honest with yourself about it. It may be worth a bad case of jitters if you get a full knowledge of your condition.

Though there is no way of proving it, we believe that early in our drinking careers most of us could have stopped drinking. But the difficulty is that few alcoholics have enough desire to stop while there is yet time. We have heard of a few instances where people, who showed definite signs of alcoholism, were able to stop for a long period because of an overpowering desire to do so. Here is one.

A man of thirty was doing a great deal of spree drinking. He was very nervous in the morning after these bouts and quieted himself with more liquor. He was ambitious to succeed in business, but saw that he would get nowhere if he drank at all. Once he started, he had no control whatever. He made up his mind that until he had been successful in business and had retired, he would not touch another drop. An exceptional man, he remained bone dry for twenty-five years and retired at the age of fifty-five, after a successful and happy business career. Then he fell victim to a belief which practically every alcoholic has that his long period of sobriety and self-discipline had qualified him to drink as other men. Out came his carpet slippers and a bottle. In two months he was in a hospital, puzzled and humiliated. He tried to regulate his drinking for a little while, making several trips to the hospital meantime. Then, gathering all his forces, he attempted to stop altogether and found he could not. Every means of solving his problem which money could buy was at his disposal. Every attempt failed. Though a robust man at retirement, he went to pieces quickly and was dead within four years

This case contains a powerful lesson. most of us have believed that if we remained sober for a long stretch, we could thereafter drink normally. But here is a man who at fifty-five years found he was just where he had left off at thirty. We have seen the truth demonstrated again and again: "Once an alcoholic, always an alcoholic." Commencing to drink after a period of sobriety, we are in a short time as bad as ever. If we are planning to stop drinking , there must be no reservation of any kind, nor any lurking notion that someday we will be immune to alcohol.

Young people may be encouraged by this man's experience to think that they can stop, as he did, on their own will power. We doubt if many of them can do it, because none will really want to stop, and hardly one of them, because of the peculiar mental twist already acquired, will find he can win out. Several of our crowd, men of thirty or less, had been drinking only a few years, but they found themselves as helpless as those who had been drinking twenty years.

To be gravely affected, one does not necessarily have to drink a long time nor take the quantities some of us have. This is particularly true of women. Potential female alcoholics often turn into the real thing and are gone beyond recall in a few years. Certain drinkers, who would be greatly insulted if called alcoholics, are astonished at their inability to stop. We, who are familiar with the symptoms, see large numbers of potential alcoholics among young people everywhere. But try and get them to see it!

As we look back, we feel we had gone on drinking many years beyond the point where we could quit on our will power. If anyone questions whether he has entered this dangerous area, let him try leaving liquor alone for one year. If he is a real alcoholic and very far advanced, there is scant chance of success. In the early days of our drinking we occasionally remained sober for a year or more, becoming serious drinkers again later. Though you may be able to stop for a considerable period, you may yet be a potential alcoholic. We think few, to whom this book will appeal, can stay dry anything like a year. Some will be drunk the day after making their resolutions; most of them within a few weeks.