Medicine: Out in the Open

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"Everyone knows how to get sober," says Michael Baar, an Albany, Calif., psychologist. "The problem is keeping them in that state." Relapse prevention is the latest attempt to help reduce the number of recovering alcoholics who fall off the wagon. Terence Gorski, president of the Center for Applied Sciences in Hazel Crest, Ill., has studied thousands of relapse cases and found that on their way to recovery, alcoholics go through specific stages, each with its dangerous temptation to return to drinking. Early on, it may be hard to cope with withdrawal. Later, the patient may falter in developing a normal family and social life. Finally, there is a period of complacency, when the recovering alcoholic no longer fears drinking as he once did. At each point, says Gorski, "the person is out of control before he actually starts to drink." His solution: counselors who meet regularly with recovering alcoholics to help them identify and face problems before they get out of hand. Says Gorski: "It is compatible with A.A. and self-help groups. The only difference is that we go beyond what A.A. has to offer."

Will there ever be a simple cure for alcoholism? Probably not. Even so, the next decade or so holds dramatic promise for advances in understanding and effectively treating the disease. Researchers hope eventually to sort out alcoholics according to the neurochemical bases of their addiction and treat them accordingly. "We are still trying to map out these neurochemical systems," says Edgehill Newport's Wallace. "If we succeed, then it is likely that we will be able to design treatments." A.A. and other groups may always be necessary to help alcoholics assess the psychological and emotional damage of chronic drinking, but there is hope that medicine may make the course to sobriety less perilous.

Medical and scientific promise, however, should not eclipse the importance of public policy efforts to curb heavy drinking among adults -- and stop it altogether among youngsters and adolescents. Education is one approach. The Government's "Be Smart" campaign, aimed at eight-to-twelve-year-olds, has had some success. Mothers Against Drunk Driving has been a primary factor in the fight that has raised drinking ages from 18 to 21 in 34 states plus the District of Columbia since 1982. Despite strong opposition from the alcohol industry, which lobbies vigorously against higher excise taxes for alcohol and warning labels on beer, wine and liquor bottles, groups like MADD and the National Council on Alcoholism continue to push initiatives that will further discourage consumption of alcohol.

In his speech two weeks ago, Health Secretary Bowen complained that brewers and beer distributors spend $15 million to $20 million a year marketing their products on college campuses, encouraging heavy drinking and "contributing to poor grades, excessive vandalism, many injuries, and not so infrequently, death." Bowen asked Education Secretary William Bennett to encourage university presidents to restrict alcohol promotions on campus. Spuds MacKenzie, the canine star of Anheuser-Busch's advertising campaign for Bud Light beer, is also in the doghouse. This fall the National Association of State Alcohol and Drug Abuse Directors filed complaints with several federal agencies charging that the campaign encouraged kids to drink.