THE NATURAL HISTORY OF ALCOHOLISM

A massive, important investigation into the roots of alcoholism--whereby Harvard psychiatrist Vaillant (Adaptation to Life) lays some issues to rest, puts ongoing problems in a clearer fight, and raises new questions and possibilities. ""Much in this book,"" says Vaillant, ""is at variance with common suppositions about alcoholism."" The reason: it looks at alcoholism from a prospective, not a retrospective, view. Vaillant's study was based on 600 men (200 socially privileged, 400 socially underprivileged) who were followed from adolescence into middle life. He sought the answers to seven interrelated questions: Is alcoholism a disease? If it's a disease, are the symptoms progressive? Are alcoholics premorbidly different from other people? Are alcoholics often worse off when abstinent than when drinking? Is return to asymptomatic drinking possible for alcoholics? How does clinical intervention alter the natural history of alcoholism? In treating alcoholics, what is the relevance of Alcoholics Anonymous? Those questions are all of import in formulating treatment, and all the subject of considerable debate. (The fifth--the possibility of asymptomatic drinking--receives a qualified ""yes"". . . from keeping tabs on persons who become social drinkers and are ordinarily lost to alcoholism studies.) The evidence suggests that the most successful treatment programs have four components: they offer a non-chemical substitute dependency in place of alcohol (a strong medical authority figure; a parental model, or the like); they ritually remind the alcoholic that even one drink could lead to relapse; they repair the medical and social damage experienced by the alcoholic; they restore the alcoholic's self-esteem. (Alcoholics Anonymous has proved to be one of the simplest models providing these components.) Vaillant makes further suggestions regarding treatment, and looks critically at others' work. Of great value to those in the field, of interest simply to the inquisitive, and even of conceivable comfort to those affected and looking for the reasons why.