Contents | Chapter 1 | ePUB | Further Reading

Stanton Peele, Ph.D., and Archie Brodsky with Mary Arnold (1992), The Truth About Addiction and Recovery. N.Y.: Simon & Schuster, Inc., pp. 47–72.

2. Are People Born Alcoholics?

A popular young entertainer jeopardized a promising career with his out-of-control drinking. Sometimes he missed singing engagements while he went on binges lasting several days. One time when he did try to appear on stage when he was drunk, according to his biographers, “he stood pale and unsteady at the mike while the orchestra played the introduction to his song.” When he opened his mouth to sing, “he vomited—on his suit front, his shoes, and on several members of his socialite audience, who had gathered close to the bandstand to hear him sing.”[1]

If this singer were performing today, he would be rushed immediately to the Betty Ford Center for treatment, after which we would read in People magazine of his gratitude to the treatment center and its twelve-step A.A. program for showing him he was a lifelong alcoholic who could never drink again. We might read later about his various relapses, but these could be handled by A.A. and the treatment center, which would always be there for him.

Actually, the singer’s name was Bing Crosby, nicknamed “Binge” Crosby early in his career. His hard-drinking days occurred more than half a century ago, when alcohol abuse was regarded as a problem in living rather than a lifelong disease. Life could still take its natural course; in this case, Crosby stopped drinking self-destructively when he began to socialize with the prominent people he previously had only entertained. As biographers Donald Shepherd and Robert Slatzer tell it, “It was during Bing’s Gatsby period that he stopped drinking himself into unconsciousness. He quit drinking entirely for a while, and when he resumed, he would drink occasionally, but never let the bottle get the best of him again.”[2] Crosby simply found that public drunkenness was not in keeping with his emerging image as a superstar.

No alcoholism treatment center in America today would turn down someone like Crosby. If they accepted Betty Ford, they would hardly turn down a man who went on three-day benders and appeared in public falling-down drunk! But what would Crosby have gained from deciding he was an alcoholic for the rest of his life instead of mastering his destructive drinking habits as he matured?

Although our current attitudes toward alcohol would actually make it harder for a Bing Crosby of today to come to terms with his drinking, somehow people still do it. Johnny Carson, for one, has said of himself on television, “I was never a good drinker.” Carson’s early abusive drinking was documented in a biography that described alcoholic rages and wife abuse.[3] Yet Carson, too, gradually cut back his drinking. Years later, following a mild relapse in which he was arrested for drunk driving after having too much wine at dinner, he said on the Tonight show, “That’s never going to happen again,” and it never did.

It was on Tonight, too, that Steve Martin told how he used to drink heavily during his early, difficult years as a comedian. Lacking confidence in his ability to win over an audience, he began emptying a bottle of gin as part of his act. Martin said that today he only drinks wine, at meals and special occasions. Instead of making speeches about alcoholism, Martin makes movies like Roxanne, a film in which people drank regularly but moderately in an atmosphere of warmth, communality, and celebration.
A biography of Robert Redford described how, as a failing young artist in Paris, he drank himself into oblivion night after night in a lonely apartment.

Rejection made Redford retreat further into himself until he was spending most of his time drinking in his room. Without food to dilute the effects, he would stare at a patch of ceiling for hours on end while his mind ran wild. Strange creatures formed in his brain and he started to hallucinate.[4]

Meanwhile, Mickey Mantle in his autobiography, The Mick (written with Herb Gluck), told how he played important games after drinking late into the morning. In this, of course, he simply imitated the great Babe Ruth and other sports stars.

Redford, Crosby, Carson, Martin, Mantle, and many other stars (such as Frank Sinatra, Rock Hudson, Nick Nolte, Casey Kasem, and Lee Marvin) drank more at one point in their lives, and to greater harm, than many who today call themselves alcoholics. Yet without resorting to that label they brought their drinking habits under control. When you look into it, you find that a large number of famous entertainers and sports figures—and a substantial proportion of the entire male population— have had periods when they could be diagnosed as alcoholics by today’s loose standards. Most outgrow their drinking problems without ever thinking to enter treatment.

Who are the “silent majority” of alcoholics and alcohol abusers who recover without treatment? Why don’t we hear them announcing on television that they overcame a drinking problem on their own and that others can do the same, while we do hear constantly from those who have joined Alcoholics Anonymous or gone to the Betty Ford Center? If we believe these public announcements—and the advertisements that treatment centers play regularly on television—we will accept disease-theory claims that people can never recover from a drinking problem if they don’t seek treatment.

Experts in the treatment industry tell us that they have never met a single alcoholic who moderated his drinking or who quit on his own, and therefore that there aren’t any. One of us once debated an official of the National Council on Alcoholism on a California radio call-in show. The first caller told us he was an alcoholic who had quit drinking on his own. The woman from the NCA claimed that this man was an exception and intoned that “over 99 percent of alcoholics, if they don’t get help, will die from their drinking.” How strange that the first call came from one of the 1 percent, the “exceptions”! Where did this woman come up with her figures? Actual data—even those compiled by researchers who swear by the disease theory—show that self-curers make up the large majority of former problem drinkers.[5]

We do hear about such drinkers and know many of them personally. Some of us may even have drunk ourselves when we were younger in a way that today would qualify us for A.A. or treatment for chemical dependency. Yet we are usually unwilling to let people know about our former drinking or substance-abuse problems. Nor do the stars who come to grips with their problems outside the Betty Ford Center want to publicize their triumphs over booze and drugs. Natural recovery from substance abuse is such a common, unremarkable process that studies find that alcoholics who enter hospitals are no more likely to become sober than those who do not.[6] In other words, even many of those who go the treatment-center route and tell us how it saved their lives would more than likely have done the same thing on their own!

Who Is Most Likely to Be an Alcoholic?

The National Institute on Alcohol Abuse and Alcoholism produced a famous poster with the banner “The Typical Alcoholic.” The poster pictured representatives of every group—young and old; white, black, Asian, Native American; men and women. The point—one emphasized constantly in popular writings about alcoholism—is that everyone is equally susceptible to this disease. Alcoholism and addiction are, in the words of so many disease proponents, “equal-opportunity destroyers.” This assertion is false. Furthermore, it is impossible to ignore its falsity.

Studies over the past quarter-century consistently show that alcoholics more often come from some ethnic and racial groups than others; they more often come from poorer socioeconomic backgrounds; they more often come from disturbed families, whether or not their parents were actually alcoholics themselves; they are far more often men than women; and young people—although not, strictly speaking, alcoholics—are far more likely to have drinking problems than old people.[7] You should be aware of many of these differences from your own life experiences, although the disease movement has labored mightily to convince you that what you know is wrong. Reaffirming the validity of your observations is, therefore, the first step toward a realistic understanding of drinking problems.

Groups with High Rates of Alcoholism

People in different ethnic groups vary tremendously in their likelihood of developing a drinking problem or becoming alcoholic. This statement can hardly be disputed; it is repeated in every piece of research, even by disease proponents themselves. For example, research inevitably finds that Irish and Native Americans (Indians and Eskimos) have very high alcoholism rates, and that Slavs, the English, and some other American Protestant drinkers are also at high risk for alcoholism. The Italians, Jews, and Greeks (and those from other Mediterranean cultures) and the Chinese have exceedingly low rates of alcoholism. In a book he wrote expounding that alcoholism is a disease, George Vaillant discovered that Irish Americans were seven times as likely to become alcoholics as Italians and other Mediterranean ethnic drinkers he studied in Boston.[8]

Vaillant also compared a group of college students with a large group of inner-city ethnics; both groups had been followed for approximately forty years. Those in the working-class population were more than three times as likely to become alcoholic as those in the college group.[9] Other research shows that blacks and Hispanics become alcoholics far more often than whites.[10] Of course, were it not for disease advocates’ propaganda, it would hardly surprise most people to discover that deprived inner-city environments produce more serious drinking problems than affluent suburban ones. What is actually more surprising is that blacks and working-class Americans are more likely to abstain from alcohol as well as to be alcoholics. This is also true for other groups with a higher-than-average risk for alcoholism, such as conservative Protestants and Southerners.[11]

How Do Some Groups Produce More Teetotalers and Alcoholics?

Another way to put this startling finding is that better-off Americans and some ethnic groups are more likely both to drink, and yet to drink without problems, than those in other groups. Those in the higher-alcoholism groups are more wary of alcohol—they have a greater fear of drinking and more often avoid it altogether. When people in these groups do drink—including some of the same people who have striven to abstain—they are more likely to develop a drinking problem. For example, George Vaillant found not only that Irish Americans had more drinking problems than Italian Americans, but that Irish Americans believed that the only way to overcome a drinking problem was to quit drinking altogether, whereas Italian Americans who overcame a drinking problem were more likely to moderate their drinking. Vaillant summarized his findings about these ethnic differences in this way: “Irish culture see[s] the use of alcohol in terms of black or white, good or evil, drunkenness or complete abstinence, while in Italian culture it is the distinction between moderate drinking and drunkenness that is most important.”[12]

Irish attitudes toward drinking and alcohol have often aroused comment. How does the Irish household inculcate the kind of drinking patterns that more frequently culminate in alcoholism? In the Irish home, the issue of drinking is often an emotionally charged one from the outset. The Irish American columnist Charles McCabe gave this version of how a young man’s first drunk is simultaneously celebrated and bewailed by various family members:

With the Irish, the treatment is tried—and untrue. All his life the kid has been hearing of the evils of the drink, and how his loving mother suffered at the hands of his rotten father because of it. And, at the end of the threnody, “Ah, but it’s in the blood, I guess.”

[After the boy gets drunk] the wrath of God descends. The priest comes into the house. He makes it clear that what you have done is worse than the violation of a vestal virgin. The mother of the house sobs quietly. The old man, craven, orders another beer at the corner saloon. . . .

If a system has been devised to produce a confirmed alcoholic to exceed this one in efficiency, I know it not.[13]

The Italians, Jews, Greeks, and other low-alcoholism cultures, on the other hand, teach youngsters to drink at meals and religious celebrations within the family. In these ethnic groups the whole outlook and atmosphere connected with drinking are different—it doesn’t carry the emotional baggage that drinking does for groups with a greater susceptibility to alcoholism. In the homes of low-alcoholism ethnic groups, alcohol is usually served at home very early to children, who see drinking occur as an ordinary part of family celebrations. What they don’t see occur when people drink is violence and drunkenness. According to a sociologist who studied the drinking of Chinese Americans in New York:

They [Chinese Americans] drink and become intoxicated, yet for the most part drinking to intoxication is not habitual, dependence on alcohol is uncommon and alcoholism is a rarity. . . . The children drank, and they soon learned a set of attitudes that attended the practice. While drinking was socially sanctioned, becoming drunk was not. The individual who lost control of himself under the influence of liquor was ridiculed and, if he persisted in his defection, ostracized.[14]

This researcher examined the police blotters in the Chinatown police district between the years 1933 and 1949. Among 17,515 arrests, he found not one arrest due to disorderly conduct associated with public drunkenness.

The Jews are a fascinating case study. Every national survey of drinking problems has put the Jews at the bottom of the problem drinking scale. At the same time, a new growth industry has developed around the enterprise of uncovering the “hidden” Jewish alcoholism problem, which is said to be suppressed because the Jewish community is so guilty about alcoholism. Two sociologists set out to demonstrate, by interviewing Jews in an upstate New York city, that alcoholism among Jews was much greater than previous surveys had suggested. Instead, the researchers found no sign that any of their Jewish subjects had ever abused alcohol. Turning to those who lectured about the alarming spread of alcoholism in the Jewish community, the researchers collected reports that there were five alcoholics in this city with about ten thousand Jews. In other words, the most dire, unsubstantiated claim was that Jews in the city had an alcoholism rate of one tenth of one percent of the adult population.[15]

The two sociologists went further and asked Jews about their attitudes toward drinking and alcoholism. They found that Jews as a group are antagonistic to the disease view of alcoholism. Jews think alcoholics drink out of a psychological dependence, and they regard problem drinkers with distaste and avoid them.[16] In other words, groups with higher alcoholism rates, like the Irish and Baptists and Slavs and Scandinavians, already fear alcohol and readily accept that alcoholism is a disease, whereas the Chinese, Jews, and Italians—groups with the lowest alcoholism rates—think of alcoholism as a self-initiated problem that can be controlled. How, we might wonder, have the people with the worst drinking problems taken over in telling the rest of us about the nature of alcoholism and how we should drink?

Furthermore, these ethnic differences in drinking really don’t surprise most people. Who, aside from people “educated” by the alcoholism movement, doesn’t know there are more Irish than Jewish and Italian alcoholics? For it is the burden of the disease movement to tell us that such differences don’t exist. The purpose of this message is to frighten us all equally about the dangers of alcohol. As the lesson of high-alcoholism cultural groups tells us, however, this fear doesn’t translate into safer drinking practices. It seems that the healthiest drinkers are secure about the role of alcohol in their worlds and proceed to drink calmly, safely, happily, and without problems—and they are repelled by and avoid those who aren’t able to do the same.

Recall the film Moonstruck (with Cher and Nicholas Cage), which was set in the New York Italian community. The movie depicted alcohol being served and consumed regularly around family, romance, eating, and socializing. These people didn’t worry about alcoholism. Hadn’t they learned the modern alcoholism movement’s message that they were in imminent danger of going overboard and becoming alcoholic? Actually, this message is itself part of the problem, and its spread has led to more alcoholism. In 1962, Mark Keller—one of the founders of the alcoholism-as-a-disease movement in the United States—estimated that there were 4.5 million alcoholics in the United States.[17] By 1985, a best-seller entitled The Courage to Change reported that “twenty-two million Americans, one out of seven, are drinking alcoholically.”[18] To say the least, discovering that alcoholism is a disease has not eliminated alcoholism the way the discovery of the Salk vaccine eradicated polio.

Hard-Drinking Groups

Not everyone functions as part of a definable ethnic group—in fact, most Americans must develop their own traditions in the absence of having clear social traditions handed down to them. And hard drinkers associate with other hard drinkers. This, too, may hardly sound like a stunning discovery. But, once again, searching for individual alcoholics who have medical conditions is not the best way to discover this truism. The author of a household-hints column, Mary Ellen Pinkham, wrote a book about her alcoholism, How to Stop the One You Love from Drinking. In it she proselytizes for getting everyone into treatment for alcoholism, treatment she claims produces a greater-than-90-percent recovery rate. At the same time she found out she was alcoholic, Mary Ellen discovered that her husband and many of those in her former drinking crowd were alcoholics and required treatment, too.

Since the disease of alcoholism is not contagious in the usual sense, it is strange how this inbred disease should show up in so many people in the same social network. Of course, what Mary Ellen Pinkham had really discovered was that hers was a hard-drinking social circle and that the group is more powerful than the individual. If you want to drink healthily, the best single thing you can do is to associate exclusively with people who drink moderately. A tougher strategy, but one that can make sense, is to organize members of the group to modify their habits together. The least sensible way to proceed is to convince the people in the group one at a time that they have a disease that requires treatment.

One group at elevated risk for alcoholism is men. Research of every type finds that men have more drinking problems than women. According to genetics researcher Theodore Reich, “Using systematic interview techniques and reliable diagnostic criteria, researchers found the six-month prevalence [of alcohol abuse] among men ranged between 8 and 10 percent, and among women, between 1 and 2 percent.”[19] Very few women have alcoholic blackouts regularly, as the worst male drinkers do.[20] This obvious discrepancy in the prevalence of female alcoholism has fueled an all-out search by the alcoholism industry for hidden cadres of middle-class women who are busy disguising their alcoholism. It just doesn’t happen that way. As one Harvard researcher who surveyed the literature discovered:

The stereotype of the typical “hidden” female alcoholic as a middle-aged suburban housewife does not bear scrutiny. The highest rates of problem drinking are found among younger, lower-class women . . . who are single, divorced, or separated.[21]

There are more female alcoholics in the same groups—Irish, blacks, lower socioeconomic classes—that have more male alcoholics, but there are always fewer alcoholics among the women than the men in these groups.

Traditionally hard-drinking groups in the United States include those in the military, in fraternities, or working on oil pipelines—in fact, just about any exclusively male society. The Berkeley Alcohol Research Group has tracked Americans’ drinking problems for decades. In their surveys, this group has found that as many as 30 percent of American men have had some kind of a drinking problem during the previous three years. The Berkeley group found that the best predictor of whether you will have a drinking problem is how many drinking problems those in the groups you drink with have.[22]

Young men up to the age of thirty have the highest levels of drinking and drinking problems among all groups of Americans.[23] In an era when people are drinking less alcohol, when we warn young people more about the dangers of alcohol, and when we have raised the drinking age from eighteen to twenty-one, youthful drinking rose through the 1970s and has remained at extremely high levels.[24] Many of these young drinkers show the kind of extreme symptoms—like blackout drinking—that are associated with advanced alcoholism. Indeed, the young of America have provided a ready supply of recruits for the alcoholism treatment movement. The average age of Alcoholics Anonymous members has moved steadily downward. Today from a quarter to a third of A.A. members are under thirty. And where there is a market like this to cultivate, private treatment centers won’t be far behind. The largest increase in hospitalizations has been among teens and young adults: hospitalization of teens more than quadrupled throughout the 1980s.[25] Most are being treated for “chemical dependence,” and they were either coaxed or coerced outright into entering the hospital.

“Maturing Out” of Drinking Problems

The Berkeley group found that, even for the large majority of problem drinkers who remain untreated, drinking problems drop precipitously by the age of thirty.[26] Most people, it turns out, simply curtail or eliminate their problem drinking with age. This phenomenon is a well known one, after all, commemorated in the phrase “sowing one’s wild oats.” In the addiction field, the process of outgrowing substance abuse is called “maturing out.”

Did you know people in a college fraternity or sorority who drank too much, or did you drink more than was good for you back then? As you may be aware, excessive college drinkers usually grow up to become moderate adult drinkers. The most thoroughgoing study of college drinkers first assessed the drinking of seventeen thousand college students in twenty-seven American colleges and universities from 1949 to 1952.[27] While in college, 42 percent of the men were classified as problem drinkers. When assessed for a second time in 1971–72, 17 percent of the men from a sample of the original group still had a drinking problem. Some problems, like binge drinking, were common in college but disappeared almost entirely after college age! In this study, problem drinking in men shows up as a normal hazard of the college years, one that infrequently persists into middle age.

Findings like these should be reassuring to those who are concerned about a teenager who may be drinking too much with friends. In their annual national survey conducted in 1988, University of Michigan researchers found 56 percent of male college students and 35 percent of female college students had consumed five or more drinks at one sitting within the previous two weeks.[28] This youthful binge drinking can be a serious problem; for example, we don’t want to see young people hurting themselves and others by driving drunk. On the other hand, since no one would claim that 56 percent of the adult male population and 35 percent of the adult female population are alcoholic, we know that most of these young people will outgrow their excessive drinking.

But it isn’t only college students or those with mild drinking problems who stop drinking excessively. Maturing out occurs at all stages of the life cycle, up to and including old age. This holds even for heavily alcohol-dependent individuals.The common occurrence of this maturation out of addiction is not questioned, even by medical experts who study the addictive process of alcohol dependence. One medical researcher who invented the “alcohol dependence” syndrome once marveled how most alcoholics “free themselves [from alcohol dependence]. The withdrawal process, and the associated desire and drive to drink, collide with the totality of the individual and the whole of life.”[29] In other words, eventually people see more reasons to quit alcoholic drinking than to continue it.

The next large drop-off in drinking problems after the late twenties is the mid-forties. Geneticist Reich summarizes: “Rates [of alcohol abuse or dependence] dropped sharply after the age of 45.”[30] A further drop in Young men up to the age of thirty have the highest levels of drinking and drinking problems among all groups of Americans.[23] In an era when people are drinking less alcohol, when we warn young people more about the dangers of alcohol, and when we have raised the drinking age from eighteen to twenty-one, youthful drinking rose through the 1970s and has remained at extremely high levels.[24] Many of these young drinkers show the kind of extreme symptoms—like blackout drinking—that are associated with advanced alcoholism. Indeed, the young of America have provided a ready supply of recruits for the alcoholism treatment movement. The average age of Alcoholics Anonymous members has moved steadily downward. Today from a quarter to a third of A.A. members are under thirty. And where there is a market like this to cultivate, private treatment centers won’t be far behind. The largest increase in hospitalizations has been among teens and young adults: hospitalization of teens more than quadrupled throughout the 1980s.[25] Most are being treated for “chemical dependence,” and they were either coaxed or coerced outright into entering the hospital.

“Maturing Out” of Drinking Problems

The next large drop-off in drinking problems after the late twenties is the mid-forties. Geneticist Reich summarizes: “Rates [of alcohol abuse or dependence] dropped sharply after the age of 45.”[30] A further drop in Most people seem to find retirement, as well as the departure of their children from their homes, relaxing rather than stressful. In addition, older people on a fixed income become less willing or able to pay for liquor. The effects of drinking are not so pleasurable in old age, and it requires extra caution to avoid getting sick or risking an accident. In the less stressful atmosphere of late-middle and old age, the payoffs from drinking go down as its costs go up. Notorious hell-raiser Lee Marvin told why he no longer drank much when he got older. “Booze doesn’t act on me like it used to—a 15-minute glow, and the next three days are yuk,” he confessed.[33] In a study of older drinkers, one researcher noted that three times as many men reduced their drinking with age as increased it. These are natural adjustments older people make to survive and continue to thrive, as well as a mark of a change in their values. This investigator related that “One man, a self-identified alcoholic, felt that he and his wife could not continue drinking and expect to be able to take care of themselves in old age. He wanted ‘a future life, my health, money in the bank. So we got together and decided to quit.’”[34]

After hearing about all those who reform their drinking on their own, perhaps you might say, “It’s easy to mellow out when you live in comfort as Robert Redford and Lee Marvin do. What do those examples have to do with my life?” But although they provide the most ready examples, the rich and famous are far from the only ones to get their lives sufficiently in order to stop drinking alcoholically. Here is the testimony of the manager of a state family-services administration, who dealt with society’s least privileged cases:

Over the years I’ve been involved in criminal cases and divorce cases, many involving people with long-lasting alcohol problems, some of them for twenty years. I’m talking about very active alcoholics, with all kinds of alcohol problems, problems with the courts, family problems, arrests. The most typical problems were at work, in dealing with authority, or at home, in raising their children. In many cases, as people got older and the stresses in their lives were reduced, they stopped drinking—either because they couldn’t take it any more physically or because they somehow grew out of it, and it ceased to be an important issue for them.[35]

Life Trajectories

Obviously, although the great majority of people temper their drinking with age, some do not. Some continue drinking at high levels, and a very small but extremely disturbing minority escalate their drinking and literally destroy themselves. Here are some typical phases of problem drinking and of maturing out:

Early maturing out. Here a person stops drinking excessively as an ordinary part of growing into adulthood, as soon as he or she develops a sufficient foothold in life. We described earlier how Robert Redford, as a young, unsuccessful art student in Paris, began drinking to the point of hallucinating. These hallucinations frightened Redford so much that he returned home, became involved with a woman, resumed his studies, and discovered acting as his primary career interest. Redford’s intense drinking period had been precipitated by his sense of isolation and failure and disappeared with his maturing into a more successful role in life.

Mid-career maturing out. Here the drinker brings his or her drinking into line with a growing sense of security and responsibility that comes with career accomplishment and stable family life. Bing Crosby, who left his binge drinking behind as he came to live in a glow of public adulation, fits this pattern. Rod Stewart also described this process to a television interviewer when the interviewer reminded Stewart he had once said the most important things in life were “soccer, drinking, women—in that order.” Stewart blushed and replied, “I said that a long time ago. Now children are the most important thing in my life.”

Late-emerging addiction. Although most problem drinkers move in a positive direction, a few go the other way. This can occur when people’s careers go off track and their early promise dissipates. Such reversal is not uncommon in the entertainment and sports worlds. Al Hodge, TV’s Captain Video, died alone and destitute in a rundown hotel. His wife had left him years earlier when he became severely alcoholic after being unable to find work. Ringo Starr drifted into chronic and worsening alcoholism after his fame as a Beatle receded. Violinist Eugene Fodor found that winning a prestigious Moscow competition didn’t guarantee a successful concert career, and fifteen years later his drug problems led to his arrest. We need always to remember that many more people become alcoholics because of failure than because of success.

Late maturing out. For a person who experiences crisis, decline, or escalating problems, two outcomes are possible: late maturation or persistent addiction. That is, while noting the worst and most intractable cases of addiction, we should realize that these are still a minority, even for those who go all the way to a full-blown state of alcoholism or addiction. The stories in Alcoholics Anonymous of people who hit bottom (or, more often, hit bottom repeatedly) and who then sober up are not examples of the power of A.A. as much as they are illustrations of the human being’s natural recuperative power. George Vaillant found, for example, that throughout the course of people’s lives, even among the most highly alcohol-dependent, more people quit drinking on their own than do so through A.A. or treatment.

Persistent addiction. What about the small minority who miss all these opportunities to mature out at various stages of the life cycle, but instead continue on the path of addiction, so as to fit the classical picture of incurable alcoholism? These individuals appear to fall into three groups.

First, there are those who are too socially isolated and economically and educationally disadvantaged to develop a productive orientation to life. These are Skid Row or other street alcoholics, whose alcoholism is marked by greater and greater separation from ordinary life satisfaction and success.
Second, there are those whose subjective experience is so painful that they require regular alcohol intoxication to make their lives tolerable. People like this (such as Richard Burton[36]) have deep-seated emotional problems for which they never find a solution and for which alcohol offers a costly palliation. They desperately seek artificial sensations of contentment and personal adequacy through alcohol, even when they experience the personal or professional successes that enable other people to outgrow alcoholism.

Third, and overlapping with the other two types of alcoholics, are those who fail to confront their worsening life situation because they are too insensitive to recognize they are escaping their responsibilities. This obliviousness is different from the disease model’s notion of “denial.” What marks this behavior is moral obtuseness, and not a blindness to a medical condition called alcoholism. Chronic alcoholics don’t have the intellectual and moral wherewithal to confront their personal limitations and the damage their drinking causes—to themselves, those around them, and their communities (as when they drive drunk or throw up in public or abuse their families).

“But Isn’t It Genetic?”

The straightforward, human view of alcoholism we have described—one that emphasizes social groups and personal responsibility—runs counter to the fashionable belief that alcoholism is an “inherited disease.” For example, a front-page article in The Wall Street Journal in 1989 erroneously announced:

Researchers have identified single genes as well as combinations of genes that are sometimes passed from alcoholics to their offspring that they believe create a predisposition toward alcoholism, much like blue eyes or nearsightedness.[37]

It is essential that we firmly refute this science fiction, which creates needless fears and concerns both about our own ability to overcome drinking problems and about our children’s susceptibility to alcohol abuse.

Here, in highlight form, is what scientific research has shown about the inheritance of alcoholism.[38]

It is true that children of alcoholics are perhaps two to three times more likely than others to become alcoholics themselves.
How much of this inheritance is due to genetic factors is open to dispute, and important studies and reviews of the research suggest the genetic component is negligible.
No genetic marker or set of genes for alcoholism has been identified.
Even those researchers who believe they have shown alcoholism may be inherited largely restrict their claims to a small group of extreme male alcoholics.
No research disputes that alcoholism takes a good deal of time to develop, and that all sorts of environmental and psychological factors—and personal choices—bring about the ultimate outcome. In other words, no one is guaranteed to become, or to remain, an alcoholic.
A majority of the offspring of alcoholics do not become alcoholic, and many make sure to drink moderately because of their parents’ negative examples.

Popular books that insist that alcoholism is purely a “genetic disease” appeal to an understandable desire we all may feel for simple answers about painful subjects, but they do not have a sound scientific foundation. Those who actually do research on the genetic inheritance of alcoholism speak far more cautiously, often downplaying the inheritance of alcoholism:

Robert Cloninger, psychiatrist and genetic researcher, Washington University: “The demonstration of the critical importance of sociocultural influences in most alcoholics suggests that major changes in social attitudes about drinking styles can change dramatically the prevalence of alcohol abuse regardless of genetic predisposition.”[39]
George Vaillant, psychiatrist and alcoholism researcher (paraphrased in Time): “Vaillant thinks that finding a genetic marker for alcoholism would be as unlikely as finding one for basketball playing. . . . The high number of children of alcoholics who become addicted, Vaillant believes, is due less to biological factors than to poor role models.”[40]
David Lester, a leading biological researcher at the Rutgers Center of Alcohol Studies, after reviewing several surveys of genetic research on alcoholism, concluded “that genetic involvement in the etiology of alcoholism, however structured, is weak at best.”[41]

Research on the inheritance of alcoholism has exploded since the 1970s. The first, and still the best-known, research of this kind was conducted by Donald Goodwin and his associates with Danish adoptees. They found that 18 percent of male adoptees with biological parents who were alcoholic became alcoholic themselves, compared with only 5 percent of male adoptees whose biological parents were not alcoholic.[42] Taken at face value, this is probably the strongest evidence of the genetic inheritance of alcoholism in all the research on the subject. Yet it shows that the great majority (82 percent) of men with alcoholic fathers do not become alcoholic solely by biological inheritance— that is, when they are not directly exposed to their fathers’ influence.

This research shows that whatever genetic inheritance predisposes a man to alcoholism has only a weak link with the actual behavior that we call alcoholism. But the Goodwin research has an even more surprising message for daughters of alcoholics. Daughters who were raised away from alcoholic parents did not become alcoholic more often than female adoptees who did not have alcoholic parents.[43] To accept the Goodwin research, the research that established in many people’s minds that there is a genetic source for alcoholism, is to reject the idea that women can inherit alcoholism! Other research confirms that alcoholism in women is hard to trace to genetic origins. But this raises an important question—if alcoholism is supposedly inherited, why is it only typed to one sex?

Quite a bit of additional evidence about genetic transmission of alcoholism has appeared since Goodwin’s research was first published in the early 1970s. Yet, despite extravagant claims about our knowledge of the genetics of alcoholism, hardly any two researchers agree on what the inherited mechanism is that causes alcoholism. Rarely do two researchers report the same findings about the brain waves or cognitive impairments or alcohol metabolizing that each suggests is a major source for alcoholism. Other researchers have conducted large-scale studies that have not found any differences between offspring of alcoholics and those who did not have an alcoholic parent in terms of alcohol metabolism, sensitivity to alcohol, tolerance for alcohol, and mood.

Not only is there contradictory evidence about when, how, and by whom alcoholism is inherited, but other research casts doubt altogether on the increased risk for inheritance of alcoholism by biological relatives of alcoholics. Robin Murray, dean of the Institute of Psychiatry at Maudsley Hospital in Britain, compared alcoholism rates for a group of identical and fraternal twins. Identical twins have the same genetic makeup, whereas fraternal twins are no more alike genetically than any brothers or sisters are. Therefore, if alcoholism were transmitted genetically, an identical twin of an alcoholic would more likely be alcoholic than would a fraternal twin of an alcoholic. Not so, Murray found. Nonidentical twins of alcoholics in his research were just as likely to be alcoholic as identical twins of alcoholics. We do not hear about Murray’s research from popularizers of science in the United States. Murray has commented: “Students of alcoholism must continually beware lest they fall victim to the extravagant swings of intellectual fashion that so bedevil the field, and nowhere is such vigilance more necessary than in considering the possible etiological role of heredity.”[44]

Research does generally find that alcoholics differ in having somewhat reduced cognitive capacity. But here is the problem. Alcoholics, as we have seen, are usually in worse socioeconomic circumstances and more often come from disturbed and abusive families. It is frequently very hard to separate these factors from any signs of impairment that offspring of alcoholics show. This may be why Marc Schuckit, a psychiatrist who has investigated college students and staff with alcoholic parents, did not find significant cognitive or neurological problems.[45] In other words, the few alcoholics who come from the middle-or upper-middle-class families that send people to college don’t inherit the traits that supposedly characterize all alcoholics.

As a result of his research, Schuckit, though arguing that alcoholism is inherited, disputes the neurological mechanisms many researchers claim to be at the heart of the inheritance of alcoholism. Instead, Schuckit proposes that the susceptibility to alcoholism is inherited in the form of a lessened sensitivity to alcohol.[46] In other words, the children of alcoholics have an inbred tolerance for alcohol that means they feel fewer effects when they drink heavily (although this description sounds very different from the stories told by A.A. members, who typically describe getting drunk the first time they drank). The person may then drink excessively without realizing it for a long enough time to become fully dependent on alcohol. In this theory, even the alcoholically predisposed individual has to drink a great deal over a long period to become alcoholic.

Another of the best-known genetic researchers, psychiatrist Robert Cloninger, maintains that inherited alcoholism is present in a minority of male alcoholics, for whom it is transmitted through paternal genes via the same route as criminality.[47] The research Cloninger and his associates have conducted in Sweden suggests that what puts children at risk for alcoholism has little to do with biochemical reactions. These researchers identified personality as the main source of alcoholism for the high-risk group of men who either drink excessively or become criminals. Children’s personalities were rated at age eleven and their alcohol use assessed at age twenty-seven. The children most likely to become alcohol abusers were relatively fearless, novelty-seeking, and indifferent to others’ opinions of them. Indeed, 97 percent of the boys who ranked very high in novelty-seeking and very low in avoiding harm later abused alcohol, while only 1 percent of those very low in novelty-seeking and average in avoiding harm did so—a difference so enormous as to dwarf any supposed biological markers of alcoholism claimed by one or another researcher! At the other end of the scale, boys who were very harm-avoidant or very sensitive to others’ opinions of them also ran a fairly high risk of alcohol abuse.[48]

Are these personality traits inherited or environmentally caused, or do they represent some combination? Whichever, they take us far away from alcohol metabolism as a prime risk factor for alcoholism. Instead, they describe types of people who become alcoholics. Few people accept that personalities, such as the “criminal personality,” are wholly formed at birth.

To do so, for example, would mean that we believe that the extremely high rate of crime among blacks is genetically caused, or that the visibility of Italians in organized crime is a biological phenomenon! Furthermore, to accept Cloninger’s theory is to believe that offspring of alcoholics are as genetically predisposed to become criminals as they are to become alcoholics.

Personality and Values in Alcoholism

Cloninger is not the first researcher to note the heavy overlap between criminal traits and alcoholism. Researchers have consistently found that the personality profile most closely associated with alcoholism involves an antisocial disposition, aggressiveness, and lack of inhibition and impulse control. Several studies, indeed, have measured these traits in college and high-school men and then successfully predicted which young people were more likely to become alcoholics, without even examining how much they drank![49] One psychologist, Craig MacAndrew, has established a scale that has regularly shown that alcoholics have “an assertive, aggressive, pleasure-seeking character” which closely resembles that found for criminals and delinquents. Women alcoholics as well as men often show this proclivity for excitement-seeking and criminality.[50]

There is a second, smaller group of alcoholics who express a great deal of emotional pain which they drink to relieve. A higher percentage of women alcoholics fall into this group. But whether a person is antisocial or not hardly seems like an inbred trait that is unaffected by environment and upbringing. Nor, on the other hand, is it likely that, just because a person has a painful sense of the world, he or she will become an alcoholic in response to these feelings. The role of personality in alcoholism suggests that a range of factors goes into producing alcoholism, even among those who find that drinking alleviates negative feelings. In addition to a predisposing personal orientation, a person must have values that set up and perpetuate the behavior we call alcoholism.

As we saw in the last section, psychiatrist Marc Schuckit finds that children of alcoholics inherit a lessened sensitivity to alcohol. Thus, they may drink more for longer periods without being fully aware of the effects. Why, however, don’t such negative signs as hangovers, criticism from family and loved ones, legal and work problems, and so on discourage their continued heavy drinking? Psychiatrist George Vaillant’s results from examining drinkers over forty years of their lives likewise demonstrated that alcoholism is the result of a long history of problem drinking. Vaillant found “no credence to the common belief that some individuals become alcoholics after the first drink. The progression from alcohol use to abuse takes years.”[51] Whether or not you have some special sensitivity—or insensitivity—to alcohol, you must persist in problem drinking for years, oblivious to all the negative feedback your behavior elicits, before you develop a full-blown addiction. Whatever your biochemical reaction to alcohol, you have to have reasons to drink regularly and excessively over such a long period.

If, on the other hand, you have reasons not to continue destructive drinking—such as conflicting priorities, values, and social pressures—it wouldn’t seem that you would continue on this path. You would heed the many warnings to change your behavior that you receive over a drinking career. The idea that many people avoid drinking too much because they don’t like the consequences of overdrinking, regardless of how their genes prime them to react to alcohol, is straightforward and logical. We all know people who say things like, “After more than a drink or two I’m really out of it, so I rarely drink that much—maybe at a wedding.” In fact, studies reveal that even young people develop strategies to control their drinking. Researchers sent nearly twenty-five hundred students at nine universities a questionnaire asking how important various reasons were in their decision to limit their drinking. The students’ answers grouped themselves into four overall motivations (listed here with a few examples of each):

Preference for self-control “I’ve seen the negative effects of someone else’s drinking.” “Drinking heavily is a sign of personal weakness.” “It’s bad for my health.” “I’m concerned about what people might think.”
Influence of upbringing and respect for authority “I was brought up not to drink” “My religion discourages or is against drinking.” “I‘m part of a group that doesn’t drink much.”
Attempts at self-reform “I’ve become concerned with how much I’ve been drinking.” “Someone suggested that I drink less.” “I was embarrassed by something I said or did when drinking.”
Performance aspirations “Drinking reduces my performance in sports.” “Drinking interferes with my studies.” “I wouldn’t want to disappoint my parents.”[52]

Here we see young people taking in feedback from the outside world, making value judgments, and adjusting their habits with a view toward health, responsibility, personal satisfaction, and social appropriateness. There’s nothing medical or mystical about it.

Children Can and Do Reject Their Parents’ Alcoholism

Even though an alcoholic is more likely to have alcoholic offspring than is the average person, nowhere near a majority of children of alcoholics become alcoholics themselves. That is, most people don’t imitate their parents’ problem drinking—at least they don’t do so over the long haul. Often, they even learn to avoid problem drinking because of their parents’ negative examples. Epidemiologists at the University of Michigan followed the drinking patterns of residents of Tecumseh, Michigan, for seventeen years, beginning in 1960. Their findings can only be called good news for those who worry that children of alcoholics, when they drink, are destined to progress to alcoholism. The researchers found that the children of moderate drinkers were much more likely to imitate their parents’ drinking habits than were those whose parents were at the high or low extremes of alcohol consumption. “That is, whereas most offspring of moderate drinkers drink moderately, most children of heaviest drinkers also drink moderately and there are more abstainers’ offspring who drink than who abstain.”[53]

They conclude, based on their evidence and a review of the literature, that

even alcoholic parental drinking only weakly invites imitation by offspring. Thus, despite the presence of familial alcoholism, the review of evidence indicates that parental heavy drinking (usually associated with interpersonal or social conflict) may not be followed closely by offspring and, in fact, that the majority of offspring seem to follow a less troublesome drinking style.[54]

Many children actually learn from seeing and feeling the consequences of a parent’s alcoholism to avoid drinking destructively themselves. Children in the Tecumseh study who were of the opposite sex from the heavy-drinking parent were especially unlikely to imitate the parent’s heavy drinking. Moreover, when a heavy-drinking parent had an evident drinking problem, this made offspring less likely to imitate them.[55] In such cases, it seems, it became easier for children to form an independent perspective on drinking and to reject their parents’ model.

The more often the parent has drinking problems, the less likely the child is to follow the same path. This finding flies in the face of the notion of alcoholism as an inherited disease. But it is entirely understandable if we just think about what people really are like. A child may well be more likely to emulate a parent who is a quiet heavy drinker than one whose drinking has visibly unpleasant manifestations. The bigger fools the parents make of themselves, the less the child will want to imitate them. Consider, in this regard, Ronald Reagan’s vivid recollections of how his mother picked his father up off the lawn after the father returned from a round of drinking, and how he himself resolved never to cause his mother this kind of unhappiness. That did not stop him, however, from drinking occasionally and moderately.

Not only are children of alcoholics not doomed to be alcoholics themselves, but several studies have shown that children of alcoholics who have developed a drinking problem do better at moderating their drinking (when that is the goal of treatment) than other problem drinkers.[56] It seems as if some childhood problems can strengthen a person’s resilience and independence. Yet today we undermine such resilience by telling the person that those problems are permanently disabling. As one woman, a moderate drinker, remarked when she received some literature about children of alcoholics, “It would have been helpful for me as a child to know that my father’s behavior when he was drinking wasn’t normal. It wouldn’t have helped me to hear that I was likely to become an alcoholic myself.”

It is in families and groups with the greatest social dysfunction—where crime and open alcoholism are most rampant and positive social values most lacking—that alcoholism is likely to be passed on from parent to child. Alcoholism is most frequently transmitted in ghetto and economically disadvantaged households and those disrupted by divorce and child abuse, where children have the fewest opportunities to escape the social and economic pressures that dominate their parents’ lives.[57] Most people who join Adult Children of Alcoholics (ACoA) groups, on the other hand, lead stable lives themselves and may have had a parent who was a “functioning” alcoholic.[58] This family structure less often produces alcoholic children. Indeed, the gigantic growth of the “Children of Alcoholics” movement—most of whose members are women with alcoholic or heavy-drinking fathers who are not alcoholics themselves—is testimony to just how many people refuse to become alcoholics merely because their parents were.

The Children of Alcoholics Movement

The term “children of alcoholics” has become a major therapeutic designation, sounding call for conferences, and means for labeling (and self-labeling) people. How do children of alcoholics differ from others who have emotional problems? According to pioneering genetics researcher Donald Goodwin, not at all.

Goodwin said that “all the stuff” that has been written in recent years about adult children of alcoholics has been, in his judgment, something akin to a hoax. Adult children of alcoholics are about like adult children of everybody else with a problem, he said, and it’s hard to build a reasonable case for giving them extraordinary attention.[59]

Children of alcoholics, like everyone else, have a range of life experiences and resulting psychological problems. Hitching these problems to your current interpretation of the previous generation’s behavior does nothing to improve your chances for dealing with life. Rather, by making your parent’s drinking problems the cornerstone of your identity, you make it harder to overcome the past and accept an adult role. The ACoA movement represents a tendency once popular among people undergoing psychoanalysis to dwell on their past to the detriment of their current relationships and activities.

If many people, even those without alcoholic parents, have the same disabilities as people whose parents drank too much, then perhaps many of us have grown up in “dysfunctional,” debilitating families. This logic has produced a whole spate of popular books, like Toxic Parents, which make it sound as though we all will bear for life the scars of our parents’ ineptitude. A guide for ACoA labels up to 96 percent of the population “children of trauma” who therefore would benefit from programs like ACoA. “Not knowing what hit them, and suffering a sourceless sense of pain in childhood,” say the authors, nearly all Americans “perpetuate the denial and minimization which encase them in dysfunctional roles, rules and behaviors.”[60] Here the fact that many people’s problems are indistinguishable from those of children of alcoholics is generalized to mean that we all need the treatments that the alcoholism movement has decided children of alcoholics require as a birthright.
What will we gain from thinking about ourselves as deformed creatures ruined by our parents’ misattempts at childrearing? Before we accept this viewpoint, let’s first make sure we are doing a better job with our own children. After all, many children of alcoholics are hardworking, responsible people. In fact, the main claim about the nonalcoholic daughters of alcoholics who buy books and attend ACoA meetings is that they are too dutiful, controlled, and perfectionistic. In other words, they are overly well-adjusted people who take on “hero” and “caretaker” roles, often becoming—as described in such books as Adult Children of Alcoholics—“super responsible.”[61] Yet the problems we are most concerned about in our children—particularly those who abuse drugs and alcohol—are the opposite ones, irresponsibility and an unwillingness to think of others.

Emmy Werner, who has studied a group of children of alcoholics over several decades, finds that they often show a heightened resilience. The additional responsibility they are given, she believes, can lead to greater competence and maturity.[62] It seems that many of our generation and previous generations had more such responsibilities than children today, and that social changes have reduced our and our children’s sense that we are obligated to others. The Children of Alcoholics movement may express a shift in cultural attitudes about how willing we are to sacrifice our own interests for other people, including our family members. For example, children today are far less willing to look after an ill parent than their own parents would have been. But this may not be a very good thing for our society or even for the people the new consciousness is supposed to benefit.

Is it possible that identifying children of alcoholics and showing them how bad their lives are can do more harm than good? What exactly do children of alcoholics gain from deciding to adopt this label and to attend groups modeled after A.A.? Janet Woititz, author of the bestselling book Adult Children of Alcoholics, reported in her doctoral dissertation that children of alcoholics attending Alateen had lower self-esteem than children of alcoholics who went untreated. Undaunted by this evidence that focusing on the traumatic effects of parental alcoholism might actually undermine the self-esteem of teenagers, Woititz observed:

Thoughtful analysis of the data and an understanding of the alcoholic family pattern can help explain this result. Denial is a part of the disease both for the alcoholic and his family. . . . This researcher suggests that the non-Alateen group scores significantly higher than the Alateen group scores because the non-Alateen children are still in the process of denial.[63]

In other words, if as the child of an alcoholic you are not sufficiently aware of your deprivation to suffer a loss of self-esteem, the movement will make clear to you just how bad your case is. Surely, Woititz’s conclusion marks the reductio ad absurdum of the disease theory of alcoholism.

Notes

D. Shepherd and R. F. Slatzer, Bing Crosby: The Hollow Man (New York: St. Martin’s Press, 1981), p. 113.
Ibid., pp. 197–98.
L. Leamer, King of the Night: The Life of Johnny Carson (New York: William Morrow, 1989).
M. Clinch, Robert Redford (London: New English Library, 19891.
G. E. Vaillant, The Natural History of Alcoholism: Causes, Patterns, and Paths to Recovery (Cambridge, Mass.: Harvard University Press, 1983), p. 187.
Ibid., pp. 284–89.
D. Cahalan and R. Room, Problem Drinking Among American Men (New Brunswick, N. J.: Rutgers Center of Alcohol Studies, 1974); K. M. Fillmore, “Women’s Drinking Across the Adult Life Course as Compared to Men’s: A Longitudinal and Cohort Analysis,” British Journal of Addiction 82 (1987): 80–111.
Vaillant, Natural History of Alcoholism, p. 61.
Ibid., p. 27.
Cahalan and Room, Problem Drinking; R. Caetano, “Drinking Patterns and Alcohol Problems in a National Sample of U. S. Hispanics,” in Alcohol Use Among U. S. Ethnic Minorities (Rockville, Md.: National Institute on Alcohol Abuse and Alcoholism, 1989), pp. 147–62; D. Herd, “The Epidemiology of Drinking Patterns and Alcohol-related Problems Among U. S. Blacks,” in Alcohol Use Among U. S. Ethnic Minorities, pp. 3–50.
Cahalan and Room, Problem Drinking; D. J. M. Polich, and H. B. Armor, J. Stambul, Alcoholism and Treatment (New York: Wiley, 1978).
Vaillant, Natural History of Alcoholism, p. 226.
C. McCabe, The Good Man’s Weakness (San Francisco: Chronicle Books, 1974), pp. 31–32.
M. L. Barnett, “Alcoholism in the Cantonese of New York City: An Anthropological Study,” in O. Diethelm, ed., Etiology of Chronic Alcoholism (Springﬁeld, Ill.: Charles C. Thomas, 1955), pp. 179–227.
B. Glassner and B. Berg, “How Jews Avoid Alcohol Problems,” American Sociological Review 45 (1980): 647–64.
B. Glassner and B. Berg, “Social Locations and Interpretations: How Jews Deﬁne Alcoholism,” Journal of Studies on Alcohol 45 (1984): 16–25.
M. Mann, Marty, Mann Answers Your Questions About Drinking and Alcoholism, rev. ed. (New York: Holt, Rinehart and Winston, 1981).
G.D. Talbott, in D. Wholey, ed., The Courage to Change (Boston: Houghton Mifflin,1984), p. 19.
T. Reich, “Biological Marker Studies in Alcoholism,” New England Journal of Medicine 318 (1988): 180.
Fillmore, Women’s Drinking; L. N. Robins,1. E. Helzer, T. R. Przybeck, and D. A. Regier, “Alcohol Disorders in the Community: A Report from the Epidemiologic Catchment Area,” in R. M. Rose and J. Barrett, eds., Alcoholism: Origins and Outcomes (New York: Raven Press, 1988), pp. 15–29; L. Ojesjo, “Risks for Alcoholism by Age and Class Among Males: The Lundby Community Cohort, Sweden,” in D. W. Goodwin, K. T. Van Dusen, and S. A. Mednick, eds., Longitudinal Research in Alcoholism (Boston: Kluwer-Nijhoff, 1984), pp. 9–25.
B. W. Lex, “Alcohol Problems in Special Populations,” in J. H. Mendelson and N. K. Mello, eds., The Diagnosis and Treatment of Alcoholism, 2nd ed. (New York: McGraw-Hill, 1985), pp. 96–97.
Cahalan and Room, Problem Drinking; M. E. Hilton, “Drinking Patterns and Drinking Problems in 1984: Results from a General Population Survey,” Alcoholism: Clinical and Experimental Research 11 (1987): 167–75.
K. M. Fillmore, “Prevalence, Incidence, and Chronicity of Drinking Patterns and Problems Among Men as a Function of Age: A Longitudinal and Cohort Analysis,” British Journal of Addiction 82 (1987): 77; K. M. Fillmore and L. Midanik, “Chronicity of Drinking Problems Among Men: A Longitudinal Study,” Journal of Studies on Alcohol 45 (1984): 228–36.
L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Illicit Drug Use, Smoking, and Drinking by America’s High School Students, College Students, and Young Adults: 1975–1987 (Rockville, Md.: National Institute on Drug Abuse, 1988).
S. Peele, Diseasing of America: Addiction Treatment Out of Control (Lexington, Mass.: Lexington, 1989).
Cahalan and Room, Problem Drinking.
K. M. Fillmore, “Relationships Between Speciﬁc Drinking Problems in Early Adulthood and Middle Age: An Exploratory 20-Year Follow-up Study,” Journal of Studies on Alcohol 36 (1975): 882–907.
L. D. Johnston, P. M. O’Malley, and J. G. Bachman, Illicit Drug Use, Smoking, and Drinking by America’s High School Students, College Students, and Young Adults: 1975–1988 (Rockville, Md.: National Institute on Drug Abuse, 1989).
M.M. Gross, “Psychobiological Contributions to the Alcohol Dependence Syndrome: A Selective Review of Recent Research,” in G. Edwards, M. M. Gross, M. Keller, J. Moser, and R. Room, eds., Alcohol-related Disabilities, WHO Offset Publication No. 32 (Geneva: World Health Organization, 1977), p. 121.
Reich, “Biological Marker Studies.”
B. Mishara and R. Kastenbaum, Alcohol and Old Age (New York: Grune and Stratton, 1980).
G. M. Barnes, “Alcohol Abuse Among Older Persons,” Journal of American Geriatrics Society 22 (1969): 244–50; D. Cahalan, I. H. Cisin, and H. M. Crossley, American Drinking Practices (New Brunswick, N. J.: Rutgers Center of Alcohol Studies, 1969); E. L. Gomberg, Drinking and Problem Drinking Among the Elderly (Ann Arbor: Institute of Gerontology, University of Michigan, 1980).
“Lee Marvin Hangs Up His Guns,” Globe, August 13, 1985, pp. 2–3.
R. Stall, “Respondent-independent Reasons for Change and Stability in Alcohol Consumption as a Concomitant of the Aging Process,” in C. R. Janes, R. Stall, and S. M. Gifford, eds., Anthropology and Epidemiology: Interdisciplinary Approaches to the Study of Health and Disease (Boston: D. Reidel, 1986), p. 293.
Authors’ oral interview with Diana Preice, August 9, 1989.
M. Bragg, Richard Burton: A Life (New York: Warner, 1988).
J. Pereira, “As Addiction Crisis Mounts, Experts Delve into the Root Causes,” Wall Street Journal. August I, 1989, pp. AI, A6.
S. Peele, “The Implications and Limitations of Genetic Models of Alcoholism and Other Addictions,” Journal of Studies on Alcohol 47 (1986): 63–73; S. Peele, “Second Thoughts About a Gene for Alcoholism,” The Atlantic. August 1990, pp. 52–58.
C. R. Cloninger, M. Bohman, and S. Sigvardsson, “Inheritance of Alcohol Abuse,” Archives of General Psychiatry 38 (1981): 861–68.
“New Insights into Alcoholism,” Time. April 25, 1983, pp. 64, 69.
D. Lester, “Genetic Theory: An Assessment of the Heritability of Alcoholism,” in C. D. Chaudron and D. A. Wilkinson, eds., Theories on Alcoholism (Toronto: Addiction Research Foundation, 1988), p. 17.
D. W. Goodwin, F. Schulsinger, L. Hermansen, S. B. Guze, and G. Winokur, “Alcohol Problems in Adoptees Raised Apart from Alcoholic Biological Parents,” Archives of General Psychiatry 28 (1973): 238–43.
D. W. Goodwin, F. Schulsinger, J. Knop, S. Mednick, and S. B. Guze, “Alcoholism and Depression in Adopted-out Daughters of Alcoholics,” Archives of General Psychiatry 34 (1977): 751-55.
R. M. Murray, C. A. Clifford, and H. M. D. Guding, “Twin and Adoption Studies: How Good Is the Evidence for a Genetic Rold” in M. Galanter, ed., Recent Developments in Alcoholism (New York: Plenum, 1983), pp. 25–48.
M. A. Schuckit, N. Butters, L. Lyn, and M. Irwin, “Neuropsychologic Deﬁcits and the Risk for Alcoholism,” Neuropsychopharmacology 1 (1987): 45–53.
M. A. Schuckit and E. O. Gold, “A Simultaneous Evaluation of Multiple Markers of Ethanol/Placebo Challenges in Sons of Alcoholics and Controls,” Archives of General Psychiatry 45 (1988): 211–16.
C. R. Cloninger, “Neurogenetic Adaptive Mechanisms in Alcoholism,” Science 236 (1987): 410–16.
C. R. Cloninger, S. Sigvardsson, and M. Bohman, “Childhood Personality Predicts Alcohol Abuse in Young Adults,” Alcoholism 12 (1988): 494–505.
H. Hoffman, R. G. Loper, and M.L. Kammeier, “Identifying Future Alcoholics with MMPI Alcoholism Scores,” Quarterly Journal of Studies on Alcohol 35 (1974): 490–98; M. C. Jones, “Personality Correlates and Antecedents of Drinking Patterns in Adult Males,” Journal of Consulting and Clinical Psychology 32 (1968): 2–12; R. G. Loper, M. L. Kammeier, and H. Hoffman, “MMPI Characteristics of College Freshman Males Who Later Become Alcoholics,” Journal of Abnormal Psychology 82 (1973): 159–62; C. MacAndrew, “Toward the Psychometric Detection of Substance Misuse in Young Men,” Journal of Studies on Alcohol 47 (1986): 161–66.
C. MacAndrew, “What that MAC Scale Tells Us About Men Alcoholics,” Journal of Studies on Alcohol 42 (1981): 617; C. MacAndrew, “Similarities in the Self-Depictions of Female Alcoholics and Psychiatric Outpatients,” Journal of Studies of Alcohol 47 (1986): 478–84.
Vaillant, Natural History of Alcoholism, p. 106.
T.K. Greenﬁeld, J. Guydish, and M.T. Temple, “Reasons Students Give for Limiting Drinking: A Factor Analysis with Implications for Research and Practice,” Journal of Studies on Alcohol 50 (1989): 108–15.
E. Harburg, D. R. Davis, and R. Caplan, “Parent and Offspring Alcohol Use: Imitative and Aversive Transmission,” Journal of Studies on Alcohol 43 (1982): 497.
Ibid., p. 498.
E. Harburg, W. DiFranceisco, W. D. Webster, L. Gleiberman, and A. Schork, “Familial Transmission of Alcohol Use: II. Imitation of and Aversion to Parent Drinking (1960) by Adult Offspring (1977): Tecumseh, Michigan,” Joumal of Studies on Alcohol 51 (1990): 245–56.
G. Elal-Lawrence, P.D. Slade, and M. E. Dewey, “Predictors of Outcome Type in Treated Problem Drinkers,” Journal of Studies on Alcohol 47 (1986): 41–47; M. Sanchez-Craig, D. A. Wilkinson, and K. Walker, “Theories and Methods for Secondary Prevention of Alcohol Problems: A Cognitively Based Approach,” in W. M. Cox., ed., Treatment and Prevention of Alcohol Problems: A Resource Manual (New York: Academic Press, 1987).
G. M. Barnes and M. Windle, “Family Factors in Adolescent Alcohol and Drug Abuse,” Pediatrician 14 (1987): 13–18.
P. Hobe, Lovebound: Recovering from an Alcoholic Family (New York: New American Library, 1990).
D. Sifford, “A Psychiatrist Discusses Creative Writers and Alcohol,” Philadelphia Inquirer, January 2, 1989, p. 5-C.
H. Gravitz and J. Bowden, Recovery: A Guide for Adult Children of Alcoholics (New York: Simon & Schuster,1987), preface.
R.J. Ackerman, Perfect Daughters: Adult Daughters of Alcoholics (Deerﬁeld Beach, Fla.: Health Communications, 1989); C. Black, It Will Never Happen to Me (Denver: Medical Administration Co., 1981); J. Woititz, Adult Children of Alcoholics (Deerﬁeld Beach, Fla.: Health Communications, 1983).
E.E. Werner, “Resilient Offspring of Alcoholics: A Longitudinal Study from Birth to Age 18,” Journal of Studies on Alcohol 47(1986): 34–40.
J.G. Woititz, “A Study of Self-Esteem in Children of Alcoholics,” doctoral dissertation, Rutgers University, 1976, pp. 53–55.