Medicine: Out in the Open

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Next month the Supreme Court will hear a case that is likely to hinge on the Justices' decision as to whether alcoholism is a disease. Two former soldiers, now recovered alcoholics, are seeking to overturn a 56-year-old Veterans Administration policy that classifies alcoholism as "willful misconduct" rather than a sickness. The VA's definition prevents alcoholics from receiving benefit extensions awarded to veterans with illnesses. In seeking to make their case, the plaintiffs' lawyers are expected to bring up the new evidence that alcoholism may have a genetic basis. Says Kirk Johnson, general counsel for the A.M.A., which filed an amicus brief in the case: "We want a medical judgment, not a ruling based on fear, misunderstanding and prejudice."

For alcoholics, the only way to stop the havoc alcohol causes is, of course, to quit drinking. That is easier said than done. The main barrier to ending the torment is the alcoholic's characteristic, and usually adamant, denial that any problem exists. Mary, 61, who has not taken a drink for 14 years, remembers blacking out and waking up with her hands trembling so badly that she could not hold a cup of coffee. "I had reasons for all those things happening to me," she says, "and none of them had to do with my drinking."

How, then, to break the psychological impasse? One way is to follow a strategy called intervention, which was pioneered in the early 1960s by Vernon Johnson, an Episcopal priest in a Minneapolis suburb. In intervention, family members, friends and co-workers directly confront the alcoholic to shatter his carefully nurtured self-delusions. Beforehand they meet with a specially trained counselor (the fee: $500 to $750) to rehearse. In the actual confrontation, the alcoholic is presented with a tough but sympathetic portrayal of the mess he is in and is urged to accept prearranged admission to a treatment center, often on the same day. Says Carol Remboldt, publications director at Johnson's institute in Minnesota: "Intervention allows a tiny aperture to be poked in the wall of an alcoholic."

The process can be painful. A 31-year-old daughter read her alcoholic parents a letter in which she described how she had seen her mother change "from the best friend I ever had" to an unhappy and unreliable woman. "The good parts of your character," she said, "are being stolen away by alcohol. Don't let that bottle overtake your life." Indeed, children often provide the most persuasive statements. One alcoholic's resistance crumbled when his son said, "Daddy, when you read me the funnies on Sunday morning, you smell." Peggi, a former schoolteacher and recovered alcoholic, remembers the day seven years ago when she was faced down by her husband, sister and three sons. "It was awful," she recalls. "But it was crucial for me to see how my drinking affected their lives."