Commentary : Forging New Drinking Habits
What a relief it was to learn from medical authorities in the 1950s that “alcoholism” was a disease. Some of us, it appears, have a biochemical makeup that places us at greater risk of becoming addicted to alcoholic beverages. While it was great to know this fatal addiction was not a sign of moral turpitude, it diverted our attention for more than a decade from another aspect of alcohol: Even for those not at genetic risk of addiction, alcohol slows reaction times, dulls the senses, impairs judgment. For anyone, alcohol and freeways are a lethal mix.
In recent years, both the alcoholic beverage industry and the alcoholism treatment industry have usually depicted alcoholism as a problem of individuals or, at best, of families. This has tended to keep us from linking alcohol itself to alcohol problems, and helped us to ignore or minimize the problems communities experience with alcohol use.
In Orange County, there are fewer than 100,000 practicing alcoholics, but nearly double that number (188,000) have problems associated with the customary or occasional use of alcohol. In 1985, alcohol dependence and associated organ damage were responsible for the deaths of about 200 of our neighbors. Another 400 died in motor vehicle crashes, fires, falls and shootings resulting from alcohol-impaired judgment.
For many of us, thanks to early training from advertisers and the silver screen, alcohol is an integral part of the good life we seek in Orange County. With more than 4,700 outlets spread throughout the county, most of us are within a short drive of a dispensary for our drug of choice. The 45,500 drunk driving arrests logged each year are testimony that we still don’t give this drug the respect it deserves: The $800 million price tag we pay in lowered worker productivity is another sign. And we are just beginning to understand the link of alcohol use to the high-risk sex behaviors that are contributing to the spread of AIDS.
High-risk alcohol use is a habit that can be changed. Alcoholism itself can be arrested, and some organ damage reversed, by the total cessation of alcohol use. With increased understanding, we may learn to place immoderate use of alcohol in the same class many now place smoking: at best, a thoughtless behavior; at worst, a “life style” disease with fatal consequences.
We pay well for our alcohol in stores, bars and restaurants. We also pay--or our employers do--to alter our drinking habits in hospitals, recovery homes and counseling clinics. Many of us avail ourselves of the cost-free mutual support to be derived from the fellowship of Alcoholics Anonymous, Alateen, Adult Children of Alcoholics and Alanon groups.
There are some, however, for whom the available private sector options are not enough--or are not accessible. I oversee a system of county services designed to help those who can’t or don’t achieve recovery through the “nonsubsidized” programs available. It is my job, also, to make sure that the more than 14,000 persons who pay their own way through court-mandated drinking driver education and counseling programs get full value for the funds they invest.
But the biggest challenge is stretching the available state and federal funds to the limit, to assure the presence of a small but effective continuum of care for the county’s uninsured and under-insured low- and mid-income alcoholics and their families who seek our help. Asking from each client only what he or she is able to pay, this system of public and privately owned programs augments client fees with taxpayers’ funds (about $1.25 per resident), and offers programs whose success rates match or exceed those of more expensive and better-publicized treatment programs.
They work so well, in fact, that even without advertising the demand far exceeds the supply. To build the system we need in Orange County to serve those who can’t get into other treatment programs would require 400 more residential beds, 46 more full-time counselors, and $2.37 more per person each year from the taxpayers who live here. All told, the county’s health services system only reaches about 4,700 of the 188,000 residents with alcohol-related problems.
Public inebriates still do “sleep it off” daily in city parks and on bus stop benches. Young people who are “into alcohol” and other drugs besides have few low-cost recovery resources available.
The shortfall of present resources is constantly apparent to those of us working in the health care system.
We turn with hope, though, to signs that people are starting to trim their drinking. Many are drinking lighter (lower alcohol content) beverages, or alcohol-free drinks at working lunches and dinners; naming a sober designated driver to take them home on Saturday nights and staging elaborate, sober grad nights.
We are recognizing that people who drink too much don’t deserve our laughter or scorn, but our concern. We are learning that drinking alcohol is a choice, not a social mandate. When the county as a whole “lightens up” on drinking, the problem drinkers who remain will stand out sooner and, one hopes, get help earlier--when the chances for full recovery are at their best.
