ALCOHOLISM CAUSES AND DYNAMICS

[Music] e [Music] I'll call ism is an almost Universal social and medical problem fortunately most people drink in moderation inappropriately in contrast an alcoholic may be defined as a person whose craving for intoxicating drink is so persistent and immoderate that it seriously impairs his personal and social adaptations and may injure his health he then becomes a medical problem in this film we shall try to demonstrate some of the psychic factors in alcoholism by tracing them to conflicts of experience failures of adaptation and the recourse to the forgetfulness of alcohol of course animal experiments cannot be directly applied to human behavior but the evidence so obtained is nevertheless a fundamental significance such experiments were first conducted by my associat and myself at the University of Chicago nearly a quarter of a century ago and have since been repeated and confirmed by Dr Jacobson in Copenhagen and by doctors Hof rter and Shanker in Vienna as you will see in the following scenes for these experiments cats are used ordinary domestic cats this for example is such a cat with its wellknown characteristics it likes food and seems to have a special desire for fish which is given here in the form of a fish cake and like all cats it likes milk it likes to play and enjoys being petted its hunting Instinct manifests itself openly on seeing a mouse tries to get a hold of it in its playful but deadly way as also is observed in many other species the animal holds a social rank amongst its fellow cats in this case our cat dominates His companion he is first in everything here for example this Tom Cat goes first to the food and satisfies himself the other cat Waits until the dominant companion has had enough and only then does it go to the dish and feed provided that there's anything left this dominance is less dependent on physical strength that on Psychic superiority established by higher intelligence aggressiveness and similar factors it is rather the superiority of personality if we may say so which is is the principal Factor such a cat can be trained to perform a complicated series of exercises becoming at the same time conditioned to receive a reward in the form of a piece of fish cake at the end of each exercise the main purpose of this training is regularity and the animal can gradually be taught to carry out tasks of increasing difficulty first the cat is trained to find a piece of fish cake in this small box every time he looks for it this is quickly learned then a lid is fixed to the box and the cat learns to lift the cover in order to get its food this too may be learned in a short time now the exercises become more difficult patiently the cat is taught to press this Square lever to obtain its re re W pressure on this lever puts the mechanism into action and a piece of fish cake is dropped into the box a few weeks later our cat has learned this difficult part of the exercise and performs it regularly now the animal is taught to wait for a signal before beginning the exercise in the course of the investigation it was found that the cat reacts to sound signals almost exclusively for example to a buzzer for demonstration purposes the buzzer has been combined with an optical signal a red light and now the cat waits for the signal then when the buzzer Rings it steps on the Square lever and then hurries over to the box to get the regular reward and as a final complication of the exercises the cat by means of pressing this round button learns to release the signal by itself again it takes the cat a few more weeks to master this complication but then finally it performs the whole series of exercises round button signal Square lever food box and reward and again round button signal lever food box reward he keeps to this sequence very closely L when a mistake is made the cat stops and begins all over again and at the end of each sequence the cat regularly gets its piece of fish cake it's entire organism is governed by the well-known phenomenon of conditioned reflex the general behavior of our cat however does not show any change as before it loves playing sleeping being caressed and so on and above all compared with its fellow cat its dominance is unaltered even when the other cat has learned to perform the same exercises when the animals are brought together our cat shows its superiority it feeds first until it is satisfied when the other cat tries to cut in a slight warning for example a quick movement of the Paw is enough to make the other cat draw back only when our cat has had enough does the other cat get its turn like any normal animal our cat detests alcohol when we add to the milk some alcohol and offer it to the cat it will sniff at this mixture but will refuse to drink it it dislikes alcohol and drinks only pure milk when we place in front of the cat several dishes containing some of the milk alcohol mixture and only one dish containing pure milk it will only drink from the one dish with the pure milk even when we distract the cat and change the position position of the dishes it will not be misled but will again find out the one containing pure milk in short the normal animal detests alcohol th the cat learns to work for an expected reward and his behavior is rot machine and effect this constitutes a completely normal response then without warning and at unexpected intervals he is frustrated at the very moment of expected gratification thus setting up an insoluble conflict the technique is simple into the food box a tube is inserted into which air is fed at a pressure of 1 5 atmospheres when we turn the tap on a blast of cold air blows into the box and onto the experimental animal except for the occasional startling blast of cold air the animal experiences no physical trauma whatsoever our cat proceeds with the usual exercises but just when it expects the fish cake reward it is frightened by the blast of cold air the cat hesitates becomes suspicious but then goes back to the box and takes the piece of fish cake then during one of the subsequent exercises cold air suddenly hits and irritates it again for the next few days the expected rewards and unpleasant surprises alternate at irregular intervals so that the animal becomes more and more uncertain of what to expect fish cake or an unpleasant surprise the cat hesitates in performing the individual stages of the exercise and is obviously torn between feelings of hunger and apprehension this seriously disturbs the conditioned reflex and creates a psychic conflict which manifests itself in the changed behavior of the cat occasionally the animal confuses the sequence it begins at the wrong place or carries out only a part of the exercise or develops substitutional actions such as scratching on occasions without ever starting the exercise the cat looks into the box to see whether there is any food left while at other times it manages to carry out the whole exercise as it was trained to do the cat becomes increasingly confused and after one more blast of cold air he gives up and with draws into a sort of Escape Corner as far as possible from the food box but nevertheless watching it intently and the longer the animal is frustrated the deeper becomes the conflict in spite of the obvious fear of the box he always feels himself drawn towards it and here again the typical substitutional act we now see At Close Quarters the conflict between hunger and fear the cat lifts the cover sees the fish cake and even raises his paw but does not dare to take the cake instead he goes back to his Escape corner where he continues to eye the box with longing fear of the Box finally becomes converted into fear of eating in the end he does not even eat his favorite food when it is placed openly beside him the hunting instinct is also depressed so it does not look at the mouse at all and may even run away from the little animal the breakdown eventually becomes apparent our cat is apathetic his coat looks unhealthy his eyes become glazed and he blinks in a way not in the least bit typical of the cat species with loss of psychic Integrity dominance is also lost when we bring him together with his companion the second cat is now dominant for example when a dish of milk is laid down the other cat goes first to feed while our cat awaits his turn with the loss of his former personality our cat has also lost his social standing when we offer him a milk alcohol mixture in his present State he first of all sniffs cautiously and then starts to drink under the influence of the alcohol a temporary change immediately occurs in the psychic condition of our cat he seems to have overcome his fear he now performs the exercises correctly he goes to the box and gets his fish cake and a blast of cold air hitting him does not bother him particularly although not returning to his former dominance he is no longer submissive and pushes the other cat away in his Endeavor to reach the milk this behavior however does not last long as the effect of the alcohol wears off our cat is once more confused and is torn between hunger and fear and withdraws again into his Escape Corner hence consumption of alcohol can clearly change the behavior of our cat and after he has consumed alcohol several times the cat perod and and if he has now given the choice between pure milk and a milk alcohol mixture the latter is always preferred in contrast to his former Behavior if we now pour milk into four bowls to only one of which alcohol is added he sniffs at the bowls but drinks only out of the one containing alcohol the cat has become an alcoholic the more the alcoholic State develops the more the behavior changes until finally he behaves in a most uncat like way he becomes apathetic movement and reaction are [ __ ] and is so lazy that he spends most of the time lying down and hardly even gets up to drink he shows signs of a complete mental and physical breakdown it has thus been shown that a state of adaptational conflict can cause Expos Al Neurosis with symptoms resembling those in human neurotic behavior and also induce a change from a preference from a for a normal diet to one containing alcohol the animal like its human counterpart will then require patient care and prolonged re-education to restore its normal behavior and to diminish its desire for alcohol only with great patience and affection can we bring the animal to forget its recent experiences and to regain its self-confidence first the attendant must establish the previous close contact with the animal which has been reduced to a minimum During the period of frustration and she must gradually induce the animal to eat fish again until finally it can do so spontaneously constant friendliness and Care restore the faith of the animal and reduce its psychic conflict then the animal must be slowly relieved of its fear of the Box this too is accomplished gradually for the cat slowly gains more and more self-confidence and can finally perform its exercises as well as it did before the frustration period the animal has completely forgotten its fear and its psychic conflict and when it now is offered alcohol it refuses it like any normal cat as the cat loses its mental conflict so it also loses its craving for alcohol experimental psychic conflict can therefore lead an animal which previously refused alcohol to taking it and even to prefer it to Pure milk by eliminating the psychic conflict we can cure the craving for alcohol at least in the experimental animal where conditions are relatively simple in man however the situation is much more complicated the neurotic tries to overcome psychic conflicts fear and states of tension or depression with the help of alcohol he takes to alcohol for its euphoriant effect but there it does not stop this is only the first link in the developmental chain after the effect of the alcohol has worn off due to the mental potentialities specific for man the original conflicts now are stronger than before and further more as the condition progresses the feelings of self- reproach loss of self-confidence the subconscious desire for self-destruction and the deterioration of the alcoholic's personal and social standing create secondary and tertiary conflicts which get stronger and stronger until they become self-perpetuating thus maintaining the craving for alcohol in other words a vicious circle has developed if alcohol is removed the sick person will try to get it and even if the patient is separated from it for a considerable number of years the consumption of a minimal amount of alcohol is enough to recreate this vicious circle and the irrepressible desire to drink thus one must try to treat the neurotic alcoholic before the stage of self-perpetuation has been reached in addition to this the variations in alcohol tolerance are of great importance the amount of alcohol which a normal person may consume before showing signs of intoxication changes during life it increases during youth then remains at a constant level until it decreases in old age in the alcoholic the tolerance for alcohol suddenly Falls sharply and from then on remains at a very low level according to several authors this drop in alcohol tolerance is symptomatic of the true alcoholic on the other hand the euphorian dose increases continuously as is the case with any addiction if we now superimpose these two curves we may distinguish several phases in the development of the alcoholic for a long time the euphorian dose is smaller than the tolerance dose which means that the neurotic can overcome his conflicts again and again by taking alcohol at this point however the minimum euphoriant dose reaches the tolerance level that means the neurotic has to get drunk to obtain a feeling of relief this stage is marked by excessive drinking and from then on the alcoholic can no longer obtain a euphoriant effect by drinking because he becomes drunk before he can get the feeling of well-being nevertheless he tries and he now enters into a phase which is characterized by periods of prolonged drunkenness when he reaches this Advanced stage a cure becomes extremely difficult treatment must be started much earlier than this in considering therapy we must bear in mind the patient his Affinity to alcohol and his relationship to society in alcoholism personality diminishes the affinity for alcohol becomes strong and rigid and the connection to society tenuous from the above it can be concluded that the following principles in treatment apply we treat the alcoholic himself to rebuild his personality a by means of psychotherapy directed against underlying causes B by means of medication for example to relieve a a state of tension and C by General measures such as diet vitamins fresh air exercise and occupational therapy in addition his relation to alcohol must be permanently severed either by making it impossible for him to obtain alcohol or by continuous use of certain drugs which make it physically impossible for him to drink and finally his relation to his family and to society should be restored by means of Social Work the above principles of treatment take time and effort but they give us hope that the unfortunate individual May once again become a useful member of society