Gains, Challenges Noted in War on Alcoholism
Betty Ford works on a deep emotional level, talking frankly about how she overcame her own alcohol addiction. Researcher Boris Tabakoff takes a clinical approach, studying genetic patterns and brain waves.
But it was clear when both appeared last week at a conference in Anaheim that they are working toward a common goal: eliminating the social stigma that keeps alcoholics from admitting their addiction and seeking help.
“Eight years and one month ago I was being treated for alcohol and chemical dependency and, thank God, fortunately, it took,” the former First Lady on Wednesday told about 200 members of the National Assn. of Alcoholism Treatment Providers (NAATP), which is based in Irvine.
“Since then, we’ve made great strides in public awareness and in the push for treatment,” Ford said. “We still have a long way to go, but after centuries of denial and heads-in-the-sand attitudes, it’s great to be where we are today.”
Lauded for Courage
Ford was presented the Nelson J. Bradley award--in memory of the Minnesota doctor considered the pioneer of modern alcoholism treatment--for the hope her “personal courage” has given others and for the “positive view of alcoholism treatment” fostered by the Betty Ford Center in Rancho Mirage near Palm Springs.
Two days later, Tabakoff closed the conference at the Anaheim Hilton by reporting that a continuing study of 80 families in which alcoholism spans three generations has revealed a startling connection between genetics and addiction.
“This is a great step forward in changing our perception of this disease,” said Tabakoff, who is acting deputy director of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) in Rockville, Md., where the family study is under way.
“The realization that genetics plays an important role in the development of alcoholism proves it is not simply a moral weakness. It is a medical problem. These people are chemically different from others.”
The conference brought directors of for-profit and nonprofit alcoholism treatment programs--many of which are competitors--together to share ideas on marketing strategies as well as treatment methods. Discussion also covered the need for clearer guidelines for admitting and diagnosing patients, placing them in treatment programs and evaluating results.
The conference was an occasion to celebrate the progress Ford symbolizes for patients and alcoholism treatment providers. (As one participant explained, “She’s a classy lady. When she admitted her alcoholism, it became OK for others to do it.”)
Areas of Concern
It was a time to focus attention on gaps in service--particularly the need for specialized treatment for the nation’s estimated 3 million teen-age alcoholics. And it was a time to ponder the effect that research breakthroughs might have on treatment of what Loran Archer, acting director of the NIAAA, called “the most hopeful of all diseases.”
Ford set the tone for the workshops ahead when she advised her colleagues to “work together” and cautioned: “The treatment of alcoholism is big business. . . . Don’t succumb to the lure of competition. Don’t let that distract you from (your main purpose)--helping patients.”
In sessions addressing patient needs, speakers discussed the trend toward specialized treatment for such groups as children of alcoholics, the elderly, teen-age alcoholics and even pre-teen-agers. The younger patients seemed to be the primary concern.
“The phenomenal incidence of drug and alcoholism problems among teens has to be dealt with,” said NAATP executive director Michael Ford. “We need education, but we also have to have a health care response to this problem.”
Inadequate Treatment for Teens
Michael Ford and others identified Orange County as one of many regions where treatment for teen-agers is inadequate.
Wade Potsch, director of Alcohol and Drug Recovery Services at St. Jude Hospital in Yorba Linda, said the county has only a handful of “viable” programs and needs more residential recovery homes to give teen-age alcoholics an alternative to hospitalization.
Gerald Shulman, a psychologist and vice president of clinical programs for the Addiction Recovery Corp. in Waltham, Mass., noted that teen-agers historically have been placed in adult recovery programs. Here, he said, they aren’t helped with such adolescent dilemmas as how to resist peer pressure and how to overcome learning difficulties, which often are aggravated by the school absences required during treatment.
Teens also may need help with social skills. For example, Shulman said, “a boy may have learned how to ask a girl out for a date when he’s drunk, but in treatment we have to teach him how to act when he’s sober.”
The drinking problem has filtered from teen-agers down to an estimated 500,000 pre-teens-agers, ages 9 to 12, Shulman said. The danger of this trend is illustrated by what Shulman called the “5-15 rule”: It takes the average adult drinker 5 to 15 years to develop an addiction, a teen-ager 5 to 15 months and a pre-teen-ager 5 to 15 weeks.
Younger drinkers are more susceptible, Shulman explained, because “they’re putting alcohol into an immature body.”
“Nobody’s doing anything” for pre-teen-age alcoholics, Shulman said. But he does see some encouraging signs at the high school level: “I see kids going to treatment and getting well.”
He said there is less denial of the problem than before among parents and school officials. And he said student assistance programs in some high schools “help kids clarify values and support kids who don’t want to use drugs.”
Importance of Detection
Teen-agers--as well as the nation’s estimated 13 million adult alcoholics--also would benefit from earlier detection and diagnosis of alcoholism, Shulman said.
A number of other conference participants shared that concern.
Some adults, said Potsch of St. Jude Hospital, are being treated for such medical problems as strokes, hypertension and heart disease while their alcoholism remains undetected.
“Treatment of secondary, related illnesses runs up horrendous costs to the health care system,” Potsch said. “Those costs go on and on because the (primary) disease has not been diagnosed or treated. There is significant documentation to show that the health care costs of the individual drop dramatically once he’s entered into a recovery program for the primary disease of alcoholism.”
Genetic Research
“It’s a situation of ignorance,” Potsch added. “We need to educate the health care field in general.”
Tabakoff may have another answer. He predicted that the genetic research now being conducted by the NIAAA “will be an important diagnosis tool in the future for early (detection) of alcoholism.”
Studies show that 4% of alcoholics “are almost predetermined” to become chemically dependent regardless of environmental influences, he said. Because of genetic traits, these people had a 90% risk of becoming alcoholics, Tabakoff said.
And, he added, heredity plays a role in the development of the disease in 60% to 70% of all alcoholics.
Drug Treatment Studied
Tabakoff also reported on another major area of research that, he said, might lead to earlier detection--and even prevention--of alcoholism. He said “preliminary results” of studies involving the use of drugs to alter electrical responses in the brain show that “one can alter an individual’s drinking patterns” with medication.
“The effect of alcohol on the brain is pleasurable, and that’s reinforcing,” Tabakoff said. These studies are exploring the use of drugs that would interfere with that pleasurable chemical response and thus reduce the impulse to drink, he explained.
In an interview after his talk, Tabakoff acknowledged that there could be a danger in treating a chemical addiction with drugs. “I don’t think drugs should be used exclusively,” he said. “But they could be an excellent adjunct to psychotherapy.”
Tabakoff noted that NIAAA researchers also are studying the effects of environmental influences such as stress.
“Alcoholism is an interaction between environmental factors and individual chemistry. The more we know about both, the better,” he said.
