Derek Rutherford, director of Britain's National Council on Alcoholism, was interviewed by senior writer John Ross Schroeder on the abuse of alcohol.
What is the difference between a drunk and an alcoholic? A person who is drunk has become temporarily incapacitated by his alcohol intake. In other words alcohol has become for him a depressant of the central nervous system. If you have taken a certain amount of alcohol, you will have depressed and anesthetized the central nervous system. You first begin to lose your judgment. Then you begin to slur your speech. But remember it is judgment first — your inability to make decisions in a sober manner. Then comes your speech and gait. If you are really drunk, you will find you have difficulty putting in your ignition key or door key. If you weren't an alcoholic and were an average person not used to taking alcohol and you have drunk a bottle of whisky, you could go into a coma — and possibly die. That is drunkenness. On the other hand, there is the type of alcoholic who has become, slowly, over the years, physically dependent on alcohol, developing a tolerance so that he or she can take more drink than you and I can and not show drunkenness. Alcoholics pass through inebriety [the level of alcohol that would make others drunk], but he or she may never show the signs of drunkenness. The alcoholic must always have a blood alcohol level that must be topped up. Otherwise withdrawal symptoms will set in. The alcoholic has become a sick man.
What treatment is available for suffering alcoholics? Anyone who has a severe drinking problem can get free help from the National Health Service. If you were to come to a local Council on Alcoholism, and present yourself to a general practitioner, a doctor would assess the degree to which you had a problem. Now it might well be that you were at an early stage and all that you needed was some therapy, individual counseling or group counseling. So one would refer you to that particular type of service. Or it might be that the doctor would like to give you a thorough examination to see if there was any damage to the liver, or whether you had any other form of damage. Or it might be that you need to be referred to one of the wards of a general hospital because you had had some damage in one of the organs of the body, and therefore you would get medical attention. It might be that you had a very severe alcohol problem with not only a question of dependence, but perhaps underlying disorders, perhaps some psychiatric disorders. You would be referred to a consultant psychiatrist for help and support.
How many addicted to alcohol stop drinking of their own volition? We don't know! What we do know is that there will be those few who are able to stop and to say no. But the vast majority become dependent. Those who are dependent have to be motivated to come off alcohol. It is their own motivation that will, of course, allow them to say no. But they need counseling support, other forms of social support and even legal support. And remember, the success rate is very poor. Of those who go through normal treatment we would say a third are able to abstain. A third, perhaps, improve their life-style. But the other third are failures.
Why does an alcoholic return to drink after the drying-out process? This is always a difficult question. Most of us don't criticize the smoker who says, "I shall give up smoking for the holidays," and then goes back to smoking with the same craving and the same type of life-style. The reasons why the smoker goes back to smoking are the same ones for the drinker going back to drink. Remember, we live in a drinking society. After a person is rehabilitated he is right back out in society. But where are his friends? His friends are in the pub. His friends are in the club. He comes home, puts on the television and he sees all the gorgeous booze being extolled on TV. You try to stop a man thinking about drinking, but immediately he comes back into a drinking society, where there is absolute pressure.
What is the National Council on Alcoholism doing about the problem of alcoholic abuse in this country? We have to look at a very wide front of prevention. First, we have to identify people who drink to the extent of harming themselves and their families. We must be prepared to find them at an early stage by alerting our primary care workers — doctors and nurses — before such a person needs a hospital bed for a peptic ulcer or gastritis or cirrhosis. Or before they become a problem to social services, by the fact that they have a battered wife, a battered child or are looking for alternative accommodation because the mortgage has not been paid. You can see the wide area there is to cover. At the work place we can identify people at the early stage and perhaps put help there. Second, we help with counseling services and support. Then we have to look at health education and to give more information about the use and abuse of alcohol in our society.
Is British society making inroads in combating the problem? If you look at the surface — the fact that we have got increasing drunkenness offenses, driving offenses, admissions to hospitals — it looks as if we are losing. On the other hand we have alerted public opinion to the fact that there is a problem in this country and a problem that needs practical decisions. However, it is very difficult to say whether we have succeeded in stemming the tide. I don't believe we have, because we are up against a massive social problem. Treatment services are not enough if you won't tackle the source of supply. You didn't get rid of cholera and TB by producing better sanatoriums. You got rid of it by looking at the water supply and river conditions and the health conditions of your people. And this is where we come back to education and looking at sensible and realistic control policies. The situation can still get worse in this country. You just have to take a look at France. One in five hospital beds in this country [Britain] is occupied by people with an alcohol-related illness, whereas in France it's almost one in two. We have somewhere in the region of perhaps 2,000 deaths from alcoholism or cirrhosis in this country each year, whereas in France, last year, there were 21,000 deaths from alcoholism compared with 20,000 deaths from tobacco related illnesses. So the position can get worse in Britain.
How serious is the industrial accident problem caused by alcohol? I think there is a gross underestimate of the problem on the shop floor of the inappropriate use of alcohol and accidents. The British have recognized the association between drinking and driving accidents, but the French were able to discover that alcohol is involved in 7 percent of all their accidents at work. Where there was a serious accident and work stoppage, 15 percent were with people with a raised alcohol level.