Medicine: Out in the Open

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Despite all the advances in knowledge and attitudes, plus the deluge of books, movies and television programs on alcoholism, the cartoon image of the cross-eyed drunk slumped in the gutter or staggering through the front door still lingers in the minds of some Americans. Not long ago many believed, as two researchers put it in the 1950s, that "alcoholism is no more a disease than thieving or lynching." Such attitudes are fading fast, to be sure, but not without leaving a residue of ambivalence. Says LeClair Bissell, 59, a recovered alcoholic and physician: "At the same time we say through our lips that alcoholism is a chronic disease, many of us feel in our guts that it's a moral or self-inflicted problem."

Yet it is a disease, and it can be a ruinously expensive one. A four-week drying-out regimen can cost anywhere from $4,000 to $20,000 for in-patient care; today medical insurance covers the tab for 70% of American workers in companies with more than 100 employees. In the early 1970s, the Kemper Group of Long Grove, Ill., was the first national insurance company to include coverage for alcoholism in all its group policies. The firm's hunch: the bill for helping an alcoholic quit today would be cheaper than nursing him through afflictions like cirrhosis of the liver and strokes later in life. The logic of acting sooner rather than later has since spread throughout corporate America. Some 10,000 firms and public agencies, including 70% of the FORTUNE $ 500 companies, now have employee-assistance programs to help alcohol and drug abusers pull their lives together and get back to work. "Before this," says William Durkin, employee assistant manager at ARCO, "the normal handling was to tolerate the alcoholic employee until he became intolerable and then to fire him."

Progress in the actual treatment of alcoholism is disappointing. Most facilities still rely on basic therapies worked out in the 1940s. Though some centers advertise grossly exaggerated success rates of 70% after four years, the best estimates are that only 12% to 25% of patients manage to stay on the wagon for three years. Alcoholics Anonymous, the tremendously popular association of an estimated 1 million recovering alcoholics, remains the single biggest source of support for chronic drinkers. But its record is hard to assess because of members' anonymity. Even so, only 15% to 20% of alcoholics get any treatment at all. Says Enoch Gordis, director of the NIAAA: "Something very important is still missing here."

Simultaneously, another shadowy fact of life about alcoholics has been dragged into the light: the severe emotional scars they leave on their spouses and especially on their children. "Years ago the focus fell solely on the alcoholic," says Carol, a mother of four and wife of an alcoholic. "Nobody identified the needs of the family." Indeed, alcohol abuse accounts for more family troubles than any other single factor. A Gallup poll this year found that one in four families reported a problem with liquor at home, the highest reported rate since 1950 and twice the 1974 rate. According to Health Secretary Bowen, alcohol is the culprit in 40% of family-court cases and accounts for between 25% and 50% of violence between spouses and a third of child-molestation incidents.