By Dr. James R. Milam and Katherine Ketcham
Reviewed by Don G.
This "classic" book on alcoholism is a fascinating, yet complex read (in the reviewer’s opinion!)
Milam describes in his opening chapter the deep schism that exists among scientists, physicians and addiction treatment facilitators over the nature of the disease of alcoholism. Alcoholism among many researchers and legislators in the United States is still regarded as a moral issue rather than a disease -- even though the American Medical Association has recognized it as a disease since 1956!
Chapter Two discusses alcohol itself - as a chemical, as a drug and as a food. The chapter describes how the body processes alcohol, and that it is selectively addictive - affecting only about 10% of the world’s population. Chapter Three discusses the predisposing factors that make an alcoholic what he/she is. Alcoholics and non-alcoholics essentially drink for the same reasons -- but at some point the alcoholic’s drinking changes from that of the non-alcoholic.
"The alcoholic appears to be using alcohol to solve his problems. The reality, however is that an abnormal physiological reaction is causing the alcoholic’s increasing emotional and psychological problems. Something has gone wrong inside." (pg. 33-34)
Chapters Four through Six discuss in great detail the progression of alcoholism from adaptation in the early stage (increased tolerance, improved performance) to the middle stage (physical dependence, craving, loss of control) to the final, deteriorative, stage of the disease (physical damage to the body from drinking, including fatty liver, cirrhosis, and pancreatitis - among a few of many ailments).
Chapter Seven shows an alcoholic as he progresses through the stages of the disease as discussed in Chapters Four through Six. Chapters Eight and Nine discuss getting an alcoholic into treatment and also discuss guidelines for looking for a treatment program. While these two chapters are helpful, there is a strong pro-AA stance to them. Milam also describes what he feels a Model Treatment Program should offer the person entering it, and what should be expected of the patient while in treatment.
Chapter Ten is on Drugs and the Alcoholic. Milam discusses how alcohol in combination with other drugs can be deadly -- especially tranquilizers. Alcoholics suffer from cross-tolerance ..." their cells are already chemically altered by long exposure to large doses of alcohol, and these alterations affect the cells’ reactions to other drugs...it accounts for the alcoholic’s ability to continue to function with tranquilizer or sedatives doses which would be incapacitating or even lethal for non-alcoholics.’ (pg.172) Milam also discusses cross-addiction in Chapter Ten.
Chapter Eleven is entitled "Beyond Prejudice and Misconception." Here, Milam discusses where he feels changes should be made in how we look at alcoholism. One of his main points is that there should be definitions that all of the scientific and medical community agree upon when it comes to alcoholism and its treatment. He discusses the need for setting alcoholic research priorities, prevention and education. One of the major points he makes is that the medical, law and insurance professions must change in their view of alcoholism.
This was considered a groundbreaking book when in was first published in 1981. In 1998, there is still much of the book that will interest the alcoholic who wants to know how the disease affects them, and what can be done about it.