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Date 7 L i 'cL 
t 
PSYCHOLOGICAL DISTRESS AND ALCOHOL ADDICTION 
by 
y 
Father Joseph Marmion 
A professional paper submitted in partial fulfillment 
of the requirements for the degree 
of 
MASTER OF EDUCATION 
with concentration in 
Counseling 
Approved: 
e Dea Graduat n 
MONTANA STATE UNIVERSITY 
Bozeman, Montana 
August, 1976 
iii 
ACKNOWLEDGEMENTS 
The author gratefully acknowledges Dr. Richard Horswill, of 
Montana State University, and Dr. Dolores Armstrong," of Seattle 
University, for their generosity and professional knowledge and time 
My gratitude also goes to Dr. Jess Lair and Senator L. W. Fasbender, 
Jr., for their efforts to alleviate the sufferings of alcoholics in 
Montana. I owe a special word of thanks to Paul Davis, Ed Boland, 
and Barry Potter for sharing their valuable experience and time with 
me. 
Finally, I would like to acknowledge my boss, Most Reverend 
Eldon B. Schuster, Bishop of Great Falls, without whose cooperation 
this study would not have been completed. 
TABLE OF CONTENTS 
Chapter 
I. INTRODUCTION . 
Need for the Study ....  
Statement 6f the Problem .    . . . 
Description of Areas Indicating Psychological 
Distress   . . . 
Social Area    
Economic Area  .......  
Spiritual Area .....   
Physical Area  
Limitations of the Study   
Definition of Terms    . . . 
II. SOME PERTINENT LITURATURE   .   
Introduction     
The State Plan for Alcoholism and Alcohol Abuse . . . 
Review of Studies   . . . 
Findings of North Central Planning Project  
The Situation in Cascade County  
The Indian Situation    
Conclusion   
III. PROCEDURE . .    . . . . . 
The Alcoholic Population  .....  
Sample    
Design ...  
Method of Contact    . 
Data and Instrumentation  
The Interview   . 
IV. RESULTS ....  
Alcoholism as a Problem  
Beginning of Problem   
Extent of Distress    
1 
2 
5 
5 
5 
6 
6 
6 
T 
7 
11 
11 
11 
12 
l6 
17 
18 
18 
20 
20 
20 
21 
21 
22 
23 
25 
25 
25 
26 
V 
Chapter 
V. SUMMARY, CONCLUSIONS, RECOMMENDATIONS ......... 33 
Summary    33 
Conclusions   .   kl 
Recommendations    1+3 
REFERENCES CITED   ........ 50 
LIST OF TABLES 
Table 
1. 
2. 
3. 
4. 
5. 
6. 
Self Perception of Degree of Psychological Distress ... 26 
Areas of Distress for Total Population 27 
Areas of Distress for the White Population   . 29 
Areas of Distress for the Indian Population ,   30 
Areas of Distress for 15-29 Age Group  31 
Areas of Distress for 30-Upward Age Group ........ 32 
vii 
ABSTRACT 
The problem of this study was to investigate the existence of 
psychological distress in people who are alcoholic. No effort was 
made to find a random sample of the population. Since the study was 
dealing with Cascade County, an effort was made to contact and inter¬ 
view one hundred and twenty individuals in the Great Falls area who 
were participants in programs especially designed for alcoholics who 
were seeking help. 
The purpose of the review of literature was to specify what the 
State of Montana had declared regarding treatment for alcoholics, and 
to determine what experts had stated in their studies on alcoholism. 
A questionnaire was designed to cover specific areas of distress 
social, economic, spiritual, and physical. The author conducted the 
interview in each case and kept an accurate account of the responses. 
The conclusions indicate that psychological distress may be a 
concomitant factor in the illness of alcoholism,and that solutions 
must be sought in an effort to cope with this problem. Greater coop¬ 
eration is necessary on the part of professionals and para-profession- 
als if any real progress is to be made. 
Recommendations are that further research be made in areas of 
treatment programs for social classes, ethnic minority people, and 
female alcoholics, A model is suggested that might be considered as 
suitable for chemically dependent individuals. 
CHAPTER I 
INTRODUCTION 
Alcohol is a drug which is acceptable and available to society. 
Professionals refer to it as a substance which "permeates, pleases, 
and yet plagues most of the world."1 Recent findings indicate that, 
(a) the economic cost associated with the misuse of alcohol in the 
United States is estimated at twenty-five billion dollars a year; (b) 
the proportion of American youth who drink is on the increase; (c) 
only a small portion of the diagnosed alcoholic population is receiv¬ 
ing the care and services they require; and (d) alcoholism is an ill¬ 
ness that can be treated.^ In other words, "Alcoholism is the most 
untreated treatable disease in the United States." 
The Alcoholism Planning Project for North-Central Montana indi¬ 
cates that there is a major alcoholism problem in the state which is 
growing on a per capita basis faster than in most other states. The 
Project also shows that Cascade County, comprizing 11.78$ of the 
state’s population was responsible for 12.4# of the total liquor 
sales for 1970.3 This information indicates that Cascade County has 
a problem of alcoholism; that the problem is on the increase; and 
that more effective approaches concerning the causes and solutions 
of the problem must be initiated and maintained. 
2 
This study will attempt to demonstrate that such factors as 
frustration, depression, anxiety, feelings of inferiority, etfc., may 
he contributing and concomitant causes to alcoholism. Psychological 
distress may be generated by adverse personal and situational life 
space conditions including economics, social, spiritual or physical 
Need for the Study 
The public is still resistant to accept alcoholism as an ad¬ 
dictive disease. Alcoholics need to be reassured that they are the 
victims of this disease and the circumstances which it creates places 
them in great Jeopardy, The moral stigma is slowly but surely dis¬ 
appearing and the alcoholic must be informed that his illness is no 
cause for shame. A questionnaire developed by Stanford University 
Institute on Research, indicates that some people still believe that 
out-dated cliche that alcoholism simply shows a ’’lack of will-power.”^ 
Current research tells us quite the opposite. . . that the alcoholic 
is often a sensitive, imaginative, intelligent and energetic person 
who happens to have genetic or chromosomal dysfunction and cannot, 
therefore, tolerate alcohol. 
There is a great need to study the problem of psychological 
distress due to the ingestion of alcohol and visa versa, the impulsion 
to ingest alcohol as a surcease to emotional disturbance. This 
3 
project 'will attempt to contribute to available knowledge by inter¬ 
viewing individual alcoholics regarding possible causes of psycho¬ 
logical distress. The project will identify some of the other persons 
affected by the psychological imbalance of the alcoholic; ie. (a) 
family and friends, (b) employers and employees, and (c) people who 
may be capable of offering services, e.g. professional and para-pro- 
fessionals. The study will indicate some possible programs which 
could be therapeutic and preventative. Professionals in the field of 
alcoholism agree that present efforts need improvement. Cascade 
County has one treatment center which can accommodate twenty resi¬ 
dents. . . this in view of the fact that the Council on Alcoholism 
indicates that there are approximately seven thousand alcoholics in 
the County alone.5 Even taking into consideration that some indivi¬ 
duals seek treatment elsewhere, it is evident that efforts to assist 
persons and help solve the problem of alcoholism have been very 
inadequate. This forces those who recognize their own needs to look 
desperately for help, but does nothing for those too sick to know 
they need help. 
Another need for the study stems from the procedural approach 
of the alcoholism service development committees. These committees 
seem to overlook the multi-factoral nature of the disease. 
Alcoholism is a mysterious disease eventuating in both physical 
and psychological devastation. Many doctors admit their inability 
k 
to treat or even to diagnose the disease. Some partial success has 
been achieved through the services of professionals and para-profes¬ 
sionals who are themselves recovering alcoholics. In fact, current 
professional literature cites many studies where real postive and 
permanent results have been shown to occur when the alcoholic is 
counseled by ’’one of his own” so to speak. However, the alcoholism 
service development plans of Cascade County do not seem to provide 
for this special aspect in their treatment program.6 Perhaps this 
innovation needs to be included. Programs that have been successful 
in rehabilitating the alcoholic, such as (a) Heartview, North Dakota, 
(b) Hazeldon, Minnesota, and (c) Galen, Montana, all use directors 
and/or counselors who are recovering alcoholics. 
The importance of City-County Health Departments and Regional 
Mental Health Centers in plans for rehabilitation of the alcoholic 
is very great indeed, but any program which does not include the re¬ 
covering professional alcoholic among its personnel must of necessity 
be inadequate. It is the scientific and professional opinion of many 
members of the National Council on Alcoholism that provisions must be 
made in every therapeutic program for the special training and uti¬ 
lization of promising recovering alcoholics. Courses at college 
and university campuses are now including the study of alcoholism on 
an interdisciplinary basis.^ 
5 
It is the belief of doctors and workers in the health science 
fields that alcoholism is a disease and as such demands a multi¬ 
dimensional approach by professionals with special expertise. This 
includes the recovering alcoholic! 
Statement of the Problem 
This study is designed to examine the extent to which psycho¬ 
logical distress due to addiction to alcohol is a factor to be con¬ 
sidered in the treatment and prevention of alcoholism. 
Descrijrfrion of Areas Indicating Psychological Distress 
This survey deals with psychological factors in a general way, 
and no attempt will be made to examine each individual case in detail. 
This study seeks to identify the psychological aspects of several 
health areas of persons addicted to alcohol and living in or adjacent 
to Great Falls, Montana. 
Social Area 
This area of study will attempt to discover the extent to which 
certain social interactions generate psychological distress in the 
alcoholic: (a) sense of worthlessness due to loss of friends and/or 
family; fear of future; (b) conflict of needs: wanting to be a 
prideful member of society but feeling very lonely and rejected; 
being made to feel inadequate on the job, and (c) sensitivity to 
6 
put-downs, criticism and unfavorable comparisons; feeling bereft of 
hope and energy; unable to set goals. 
Economic Area 
This area of study will attempt to discover factors which inhi¬ 
bit productivity and create futility in living: (a) feelings of 
inferiority due to lack of work skills; inability to utilize creative 
talents due distrust and lack of opportunities, (b) poor social 
status because of job loss; inability to "hold down" a job, and (c) 
sense of hopelessness and helplessness because of lack of job secur¬ 
ity; pressure of unpaid bills. 
Spiritual Area 
This area of study will discover whether guilt and forgiveness 
are psychological factors which each person must deal with on a day- 
to-day basis: (a) sense of Abandonment; sense of betrayal of God’s 
love and guidance, (b) sense of pervasiveness of remorse and guilt; 
inability to maintain spiritual orientation, and (c) sense of low 
self esteem; no awareness of personal identity or personal power. 
Physical Area 
This study area will try to ferret out attitudes which tend to 
depreciate and down-grade the self concept because of physical handi¬ 
caps or perceived ill health: (a) fefelings of shame and self 
T 
effacement due to real or imagined physical inadequacies, (b) worry 
over bodily health, refusal to admit illness, and (c) self deprecia¬ 
tion and/or self destructive behaviors. 
Limitations of the Study 
The sample population of this study consists of one hundred 
and twenty alcoholic persons, . , so designated by examination and 
opinion of several experts, including medical doctors. All sampling 
will be done in the Great Falls area; alcoholics who live outside of 
the city and those who attend treatment centers within the city will 
be considered part of the continuing programs in Great Falls. The 
number of individuals included in this sample will consist of 2% of 
the approximated alcoholic population. It will also include both 
white and Indian samples. This pseudo-selection will happen more by 
chance than design. The sample will be studied for differences among 
and between the respondents concerning age, sex, cultural heritage, 
residential area and social status. 
Definition of Terms 
Alcoholism: The following is the definition given by Mark Keller of 
the Center of Alcohol Studies at Rutgers University, and is accepted 
by the World Health Organization: 
Alcoholism is a chronic disease, or disorder of behavior 
characterized by the repeated drinking of alcoholic 
8 
beverages to the extent that exceeds customary dietary use 
or ordinary compliance with the social drinking customs . 
of the community, and which interferes with the drinker's 
health, inter-personal relations, or economic functioning. 
Psychic Distress: This is inordinate pressure resulting in extreme 
anciety, fear, frustration, depression, feelings of inadequacy, 
feelings of insecurity, or feelings of guilt. This psychic distress 
may arise from conflict either on the conscious or the unconscious 
level.9 
Alcoholic Program: Any program used by alcoholics for the treatment 
of alcoholism and/or maintenance of sobriety. 
Alcoholic Population: Those people who refer to themselves as being 
alcoholic, or who definitely qualify to belong in relation to the 
given definition. 
Alcohol Problems: Those problems related to the use of alcohol, but 
not necessarily relating to the disease of alcoholism. 
Adequate Programs: Those programs which are sufficient to meet the 
needs of all individual alcoholics, so that they can be helped to 
regain health. 
Drug: Any substance foreign to the human body that is taken as a 
mood changer or as an anesthetic. 
9 
Self-Revelation: ^ Disclosing matters about self that are of a very- 
personal nature. This is done either to another individual or to a 
group of individuals such as in counseling sessions or in group 
therapy. f 
Addiction: According to the federal statutes, a drug addict is any 
person who "habitually uses a habit-forming drug. . . so as to en¬ 
danger the public morals, health, safety, or welfare, or who is or 
has been so far addicted to the use of such habit-forming narcotic 
drugs as to have lost the power of self-control with reference to his 
addiction. 
Treatable: Individuals who can be given help which will enable them 
to feel better and be able to accept themselves and society in a 
more meaningful way. 
Professionals: Those people who have been trained for a profession, 
and whose cooperation is necessary in order that adequate community 
programs can be established, 
Mal-function of the Intellect: This refers to the situation where 
proper reasoning is interfered with. 
Prevention of the Disease: This refers to the situation where a 
person is not yet addicted. However, certain symptoms may indicate 
10 
that contraction of the disease is probable. Certain programs may be 
used to bring these facts to the attention of the individual, and he 
is thereby able to avoid the use of alcohol before it becomes a pro¬ 
blem. 
CHAPTER II 
SOME PERTINENT LITERATURE 
Introduction 
Scientific interest in alcoholism had its beginnings at Yale 
University in the 1930’s. Much of the findings have been published 
in the Quarterly Journal of Studies in Alcohol, 
The Federal Government began to support the movement in the 
1950*s and, through the efforts of Senator Harold Hughes, the National 
Institute on Alcohol Abuse and Alcoholism came into existence in 1966. 
At the state level, much legislation has been introduced, and 
in 197^ the state of Montana, in a bill introduced by Larry Fasbender, 
recognized? (a) the disease, (b) the magnitude of the problem, and 
(c) the need for the implementation of detailed proposals. The Leg¬ 
islative Session declared its policy as follows: 
It is the policy of the State of Montana to recognize 
alcoholism as an illness and that alcoholics and in¬ 
toxicated persons may not be subjected to criminal 
prosecution because of their consumption of alcoholic 
beverages but rather should be affored a continuum of 
treatment in order that they may lead normal lives 
as productive members of society.H 
The State Plan for Alcoholism and Alcohol Abuse 
The State Plan proposes that treatment centers shall have 
qualified staff members such as counselors, psychologists, social 
12 
workers, psychiatrists, and clergymen. It also states that the goals 
are to train hoard directors, professionals, and para-professionals, 
and to provide for emergency medical services.1^ 
Review of Studies 
Most of the studies indicate that there are complex factors in¬ 
volved in the disease of alcoholism. They can’t seem to he able to 
discover any one factor that can explain the reason for the illness. 
The American Medical Association holds that: "No single factor, 
hut rather a complicated interplay of physiological, psychological, 
and social factors lead to the origin and development of alcoholism."1^ 
Also, Milton A. Maxwell, of Rutgers Center of Alcohol Studies 
says: "The degree to which any factor may play a ’causal’ role may 
vary from individual to individual. So may the comhination of factors 
vary." ^ 
Why one person rather than another is addictively predisposed is 
not clear. Ernest H. J. Steed says: "Alcoholism is a dependency on- 
alcohol brought about by the conscious or unconscious neglect or im¬ 
pairment of either the physical, mental, social, or spiritual dimen¬ 
sions of the individual. This neglect or impairment in one or more .of 
these four faculties can precede the taking of alcohol and certainly 
develops after the taking of alcohol.nl5 
13 
These studies claim that there is no single factor that is the 
cause of alcoholism. However, they all indicate that the disease can 
be controlled. With regard to this, Florence Powdermaker wrote in 
the Quarterly Journal on Alcbhblism as early as 19^4 that it was 
essential that the therapist have no hidden or overtly critical atti¬ 
tudes towards the symptoms. She stressed that the effective therapist 
should have ’’sincere appreciation of the patient’s capacities and po¬ 
tentialities, and friendliness toward him,”l6 
The literature shows how. the Federal Government and the States 
recognize the need for programs to deal with problem drinking. How¬ 
ever, the task of actually setting up such programs is made difficult 
because of misconceptions people have about alcoholism. Many people 
agree on the existence of this social illness. What the illness is, 
how extensive it is, what steps to take in order to deal with it— 
all are factors they don’t seem to understand. 
According to a questionnaire developed by Stanford University 
Institute for the Study of Human Problems, there are a wide variety 
of ideas, theories and opinions. They can be divided into eight 
different categories: (a) a specific type of disease, (b) a symptom 
of an underlying emotional disorder, (c) a symptom of a character 
disorder, (d) a neurotic behavior, (e) an allergy, (f) a moral dis¬ 
order, (g) lack of will-power, and (h) a social deviance.1? 
Ik 
Studies show that hospital staffs have negative attitudes toward 
alcoholics, James W. Middleton, Jr., in 1971> explored the feasabil- 
ity of studying the economic aspects of treating problem drinkers in 
general hospitals.-^ 
He found that staff attitudes toward treating alcoholics were 
negative. Most of them gave their opinion that alcoholics should be 
treated in alcoholic centers, that Alcoholics Anonymous was the proper 
referral agency for the patients, and that they were more interested 
in taking care of the more respectable duties. 
With regard to the existence of psychological distress in the 
alcoholic, Dr. Donald H. Peterson in his address to the First North 
American Conference on the Halfway House Alcoholism Programs, said: 
”1 want to emphasize one thing to you at this time. It 
is this Escape mechanism’ that is responsible for the 
ultimate, addictive predisposition—because the individual, 
once he learns the feeling of comfort, is at that point 
'hooked1, and I mean this with all sincerity. Indeed, I 
am totally convinced that I am not treating 'alcoholic 
addiction', or 'barbital addiction', or harcotic addiction', 
or 'feeling addiciton', or ’’mood addiction', because the 
addictively predisposed individual does not care what he 
takes as long as he accomplishes his end. 
Gibran, the Lebanese poet, said, 'Comfort enters the 
house as a guest, then becomes host, and finally masters.' 
We must remember here that the cycle becomes complete 
when the escape route becomes part of the problem. !,19 
The Cooperative Commission selected by the government suggests: 
’’Although the precise role of the various factors has not 
been determined, it is possible to develop a tentative 
15 
model. An individual who (a) responds to alcohol physio¬ 
logically by experiencing intense relief and relaxation, 
and who (b) has certain personality characteristics such 
as depression, anxiety, and frustration, and who (c) is 
anmember of a culture in which there is both pressure 
to drink and culturally induced guilt and confussion re¬ 
garding what kind of drinking behavior is appropriate, 
is more likely to develop trouble than most other people."20 
Dr. Albert Ullman has suggested that rates of alcoholism are low¬ 
est in cultures where norms and sanctions with regard to alcohol con¬ 
sumption are well established and agreed upon by all, while it is 
relatively high when conflict, guilt feelings, and uncertainty are 
present.2^ 
A study of Yellowstone Countyv /with a population corresponding 
to Cascade County, shows that the age group 15-29 years demonstrates 
a large numerical percentage of higher risk in relation to problem 
drinking. The 15-19 age subgroup represented the largest percentage 
pp 
of high risk of all age grouping. 
The problem involved in evaluating teenage drinking is in regard 
to determining what percentage of the high risk group is actually 
alcoholic, or likely to be alcoholic. There is a difference between 
problems relating to drinking and the disease of alcoholism. 
Maddox and McCall, in a study of 2,000 Michigan High School 
students, found that nearly 92# had drunk or tasted alcohol, but 
only 23# continued to drink alcoholic beverages occasionally. He 
reports that young people have various reasons for drinking. Among 
16 
young people as among adults, the probability that an individual will 
be a user varies. 
Jay N. Cross,says: "Misbehavior by young people, when accompa¬ 
nied by drinking, is always attributed to the alcoholic beverage. . . 
but little useful data is available to clarify this allegation."2^ 
Findings of North Central Planning Project 
The Alcoholism Planning Project for North Central Montana in¬ 
dicates that: 
(a) Montana has a major alcoholism problem which is growing, on 
a per capita basis, faster than in most other states. 
(b) Cascade County comprizes 11.78# of the state's population, 
and 12. Vf# of the total liquor sales for 1970. 
(c) Present programs dealing with Alcohol Abuse and Alcoholism 
are accorded a low priority. 
(d) Existing research, laws, and activities have not been ef-. 
fectively mobilized. 
(e) This leads to the inability of local institutions, agencies, 
and other organizations to recognize their responsibility for meeting 
alcohol-related problems. 
(f) Shortage of professional personnel and increasing demands 
for services.demonstrates that the ability to care for people with 
problems resulting from alcohol needs more para-professional persons. 
IT 
(g) Many private and general hospitals are slow to implement new 
provisions for care of patients who have alcohol-related problems, and 
this situation reinforces society’s denial that alcoholism is a sig¬ 
nificant health problem. 25 
The Situation in Cascade County 
The Cascade Council on Alcoholism, in its application for fed¬ 
eral and state funding for Providence Resocialization Treatment Center, 
summarizes its justification as follows: 
(a) There is a rising rate of alcoholism in Cascade County. 
(b) Additional staff is needed to provide adequate services for 
individuals. 
(c) Methods must be found to make the general public and the 
different agencies aware of the magnitude of the problem of alcohol¬ 
ism. 
(d) There is a need to seek out and identify the alcoholic so 
that he can be treated. He must be informed and confronted. 
(e) There will have to be funding for staff training in special 
alcohol information and counselor programs on the academic level. 
(f) Services need to be made available to families and employers 
of alcoholic individuals. 
Cg) Approximately half of the population of Cascade County is 
affected—directly or indirectly—by the disease of alcoholism. u 
18 
The Indian Situation 
The Indian population might be regarded as deserving special 
consideration in research programs, but, because they do experience 
alcoholic problems, they cannot be excluded from a study which examines 
an area of which they are a significant part. To treat them other¬ 
wise might give the impression that they are not regarded as being 
part of society. In fact, a study of this nature will hopefully show 
any differentiating factors between sub-populations that might exist, 
as well as the extent of those differences. 
Local studies show that both Indian and white populations have 
similar psychological distress factors, that programs based on racial 
integration are beneficial to both populations, and that socialization 
rehabilitation requires some involvement with all segments of society. 
This has been experienced in programs in the Great Falls area, such as 
at the Providence Resocialization Center and the Alcoholics Anonymous 
Programs where both whites and Indians participate in the same groups, 
with quite a noticeable amounti.of success. 
Conclusion 
This study is designed to explore some of the problems of 
alcoholics in Cascade County. It will examine whether the information 
found in the literature applies to this section of the population; 
19 
what areas of personal distress require attention; and how solutions 
may be initiated. 
CHAPTER III 
PROCEDURE 
The Alcoholic Population 
According to the Cascade County Population Census for the year 
1968, the urban distribution amounts to approximatley seventy-five 
thousand people,These figures refer mainly to the Great Falls area 
as it is the only large city in the County. The increase in popula¬ 
tion since that time is not considered significant for the purpose of 
this study. What is significant is the fact that the Montana State 
Plan for Alcoholism and Alcohol Abuse states that the highest risk 
area for addiction is the age group 15-19 years.2® The current popu¬ 
lation census shows that there are approximately fifty-four thousand 
people fifteen years old and upwards in the Great Falls area.29 
Studies show that one out of nine social drinkers is an alcoholic. 
The Cascade Council on Alcoholism states that there are seven thousand 
and more alcoholics in the County. 
Sample 
This study does not claim to be representative of (a) the alco¬ 
holic population of Cascade County or even of (b) that stratum of the 
population which seeks help for the disease of alcoholism through 
attendance at specialized programs. What is does do is to examine 
21 
the needs of some of the persons who participated in some of the pro¬ 
grams. The criteria for participants in the survey was that they had 
sought help for their problem of drinking through special therapy 
programs of Cascade County, Montana. It was felt that such persons 
would be worthy of belief since it takes anhhonest person to admit 
that he has a drinking problem. The assurance of experiencing and 
maintaining sobriety depends upon the capacity to be honest with self 
and with others. Both of these conditions were fulfilled by the par¬ 
ticipants in this study. 
Design 
This project will establish by interview and questionnaire that 
there is a stratum of the population of Cascade County, Montana, that 
appeared to use alcohol to ’’the exclusion of more appropriate ways, 
to obtain relief from anxiety”.3-1- One of the assumptions of the study 
is that: ’’Alcohol is chiefly taken for its pharmacological reactions 
which are those of a depressant. The use of alchhol can, therefore, 
bring temporary relief from anxiety and psychological distress pro¬ 
duced by the stress and strain df everyday living.”^ 
Method of Contact 
A suitable and convenient way to contact persons addicted to 
alcohol is through programs which specifically serve this type of 
22 
clientele. Generally, members of these groups are concerned about 
getting well and have acquired an openness and honesty concerning 
their problem with alcohol. Those alcoholics who have not yet acknow¬ 
ledged their need for assistance would not be trustworthy respondents. 
Therefore, the sample of this project is necessarily selective since 
it is restricted to alcoholics seeking help. The author will become 
acquainted with programs established for rehabilitation of the alcb- 
holic and interview one hundred and twenty participants. A prepared 
questionnaire will be used by the interviewer to record the statements 
verbatim of the sample population. The questionnaire will include 
areas which will ellicit aspects of psychological distress. It is 
assumed that alcoholics will react in a meaningful way to these ques¬ 
tions. 
Data and Instrumentation 
The data will be collected by personal interview because of: 
(a) the nature of the information required; (b) the relationship which 
exists between the author of this study and the respondents; (c) the 
knowledgeability of the author and his background of research in this 
field; (d) the necessity of clarifying exactly what information is 
required; and (e) the purpose of collecting accurate information. 
23 
The Interview 
The interview will consist of the following questions: 
1. Do you consider yourself to be an alcoholic? 
2. Why do you consider yourself to be an alcoholic? 
3. Can you recall when you began to use alcohol frequently? 
4. Did you feel that you actually needed alcohol? 
5. Was alcohol used as a means of escape from something? 
6. Was there a feeling of psychological distress before 
using alcohol? After using alcohol? 
7. Would you consider that the psychological distress 
experienced by you was: normal  
more intense than normal  
extreme  
other  
8. What were the areas or sources of this distess? 
physical  
economic  
social   
spiritual  
An open and honest answer to these questions may be expected to 
the extent that participants can be honest in evaluating their own 
problems from self-awareness; this is supported by the fact that mem¬ 
bers attend the therapy sessions of their own free choice. They be¬ 
lieve that their rate of recovery and their maintainence of sobriety 
depends on the degree to which each can enter into the spirit of 
2k 
honest self-revelation. Members of programs dealing with alcohol re¬ 
habilitation become familiar with this kind of personal revelation 
which becomes a catharsis for them. It is understood that anonymity 
is to be completely respected. 
CHAPTER IV 
RESULTS 
Alcoholism as a_ Problem 
All of the respondents agreed that they considered themselves 
to he alcoholic. The reasons for this self-diagnosis were that: (a) 
each seemed to he powerless over the craving for alcohol, (h) each 
life had become unmanageable because of alcohol, (c) drinking habits 
had interferred with job stability, and last but not least, (d) mar¬ 
riage and home life were severely impaired and distorted. They were 
convinced that: (a) they needed professional help in order to be able 
to overcome the problem, (b) they were forced to seek help from pro¬ 
grams which specifically offered assistance to alcoholics,vand (c) they 
believed that they could not continue to ingest alcohol and lead a 
healthy and responsible life. Eighty-five men and thirty-five women 
were included in the survey; this included both the Indian and the 
white population. 
Beginning of Problem 
All participants in the sample were definite about their need 
for alcohol; it had come to supercede all other personal or social 
needs. Alcohol was used as a means of escape from psychological dis¬ 
tress, However, as alcohol assumed the compulsion of addiction. 
26 
drinking led to many more complex difficulties and so the vicious cir¬ 
cle "began! Continued drinking always led to more jeopardus "behavior. 
Eventually alcohol became the only means available to trying to cope 
with the stresses and strains of living. 
Extent of Distress 
Each individual person included in this survey regarded his own 
distress factor as being either extreme or more intense than ’’average” 
or ’’normal”. This unique characteristic of each individual became 
more apparent as the interview progressed. What was a source of dis¬ 
tress, psychologically speaking, for one person seemed not so signifi¬ 
cant to another. The personal feelings of each person were respected 
whether the interviewer was soliciting responses from individuals or 
from members of a group. In this way, each person was afforded uncon¬ 
ditional positive regard; this acceptance of individuals and group 
members has proved to be an important factor in therapy. 
TABLE 1 
SELF PERCEPTION OF DEGREE OF PSYCHOLOGICAL DISTRESS 
Normal More Intense Extreme Total 
0 2k 96 120 
27 
Table one at the bottom of the previous page expresses a value 
judgement concerning the individual’s perception of the degree of 
psychological distress which he experienced. Each respondent said 
that the psychological distress in their lives became so great that 
to ease the unbearable feelings of guilt, failure, futility, alone- 
ness, hopelessness, etc., they had no recourse but to ’’drown out” these 
obsessive thoughts with alcoholic oblivion, 
v 
TABLE 2 
AREAS OF DISTRESS FOR TOTAL POPULATION 
Spiritual Economic Physical Social Total 
Male 2 30 6 6l 85 
Female 5 k 2 29 35 
The above table indicates the four areas in which psychological 
distress was evident. The areas of greater distress for both men and 
women were economic and social. But even the threat of economic loss 
was not as psychologically devastating as the sense of alienation and 
aloneness which the true alcoholic experiences. Seventy-one percent 
of the men and 82$ of the women indicated that the deterioration of 
social relationships before, during, and after their drinking bouts 
caused them acute psychic pain and distress. Few could find words to 
tell about or explore this feeling of utter failure and rejection! 
28 
The large number who recalled great emotional or psychological 
distress in the area of social living gives cause for poignant con¬ 
cern. The alcoholic wants nothing more than to be accepted by his 
family, peers and social mulieu—to be counted among those persons who 
are needed and wanted in society. Basically the alcoholic is a sad 
person inside. This may be the reason for some of his acting-out be¬ 
havior. It is an imperative, therefore, that any attempt to rehabili¬ 
tate the alcoholic must include information and experiences which can 
bring about change of attitude and behavior—from isolation to a 
feeling of self worth and "being at home" in the human race! 
The physical area did not seem to generate much distress. Per¬ 
haps this was due to the fact that the alcoholic, traditionally, pays 
little attention to how he is feeling and concentrates on the expec¬ 
tant feeling accompanying alcohol ingestion. 
Similarly, the spiritual area did not appear to be important. 
In discussing this aspect, the respondents said that until the illness 
of alcoholism had progressed considerably, the spiritual life was 
ignored, forgotten, or repressed. But as the disease became chronic, 
it was the spiritual factor which dominated the thinking or waking 
life of the alcoholic. In any rehabilitation program the spiritual 
area should be stressed since it alone can bring real meaning, hope, 
and inner strength and healing to the disoriented heart! 
29 
TABLE 3 
AREAS OF DISTRESS FOR THE WHITE POPULATION 
Spiritual Economic Physical Social Total 
Male 2 29 5 46 7Q 
Female 3 1 1 15 21 
Table three indicates a significant difference (29 to l) between 
white men and white women in relation to the economic area. No doubt 
this may be accounted for by the fact that fewer women work who are or 
who have been alcoholic. Another factor may be that many of the men 
were in executive jobs or were in business for themselves. Management 
is always exposed to much more social and personal pressure. Wage 
earners, both men and women, were concerned whether they were in the 
right kind of job and what the chances were for promotion. Many ex¬ 
perienced severe frustration because they felt their capabilities were 
not recognized. All workers at every level reported having difficulty 
relating to other persons, whether at work or on social occasions. 
Some changed jobs frequently in order to escape the boredom, frustra¬ 
tion or sense of inferiority. 
30 
TABLE 1* 
AREAS OF DISTRESS FOR THE INDIAN POPULATION 
Spiritual Economic Physical Social Total 
Male 0 0 1 15 16 
Female 2 0 1 14 IT 
Table four indicates that the area of maximum threat for Indians 
vas the social area. All of the Indian population that was surveyed 
reported having great difficulty in relating to the larger society. 
Numerous reasons were given for this sad state of alienation, the most 
important being the in-bred feeling of not being worthy or accountable 
This feeling is, without doubt, due to the years of segregation and 
demeanment which Indian reservations perpetuate. 
Some respondents felt that an important factor was the prejudice 
that still exists towards the native American. Even Indians who ser¬ 
ved in the armed forces or who worked in hospitals or cafes felt un¬ 
comfortable because of the white men’s cruel remarks and often hostile 
attitude. Women felt that the inferior education on reservations in 
no way prepared them for the competitive outside work market. Some 
Indians who had attended public schools and colleges felt inferior 
because the majority of students were white, teachers were white, and 
all ignored the Indian! As with all minority group members, Indians 
31 
relate better to instructors or bosses who belong to their own ethnic 
group. It is still an ’’inspiration" to minority members to have one 
of their own "make good’’!. Contrary to the stereotype, Indians are 
proud people—brave people who still cherish the unhearIded feats of 
courage and integrity which their leaders showed before it was taken 
from them! 
TABLE 5 
AREAS OF DISTRESS FOR 15-29 AGE GROUP 
Spiritual Economic Physical Social Total 
Male 0 0 0 6 6 
Female 0 0 0 2 2 
Table five indicates that the age level 15-29 years represents 
about 6$ of the total population of the study. Though the sample of 
this age bracket is small, it again accentuates the fact that human 
relations are the most crucial area of psychological distress. People 
become human by contact with other caring and supporting persons. It 
should be a matter for study and action by each county to review pro¬ 
grams to determine if the area of social enrichment is receiving 
adequate emphasis. Better yet, are socialization activities predom¬ 
inant in programs of prevention? 
32 
TABLE 6 
AREAS OF DISTRESS FOR 30-UFWARD AGE GROUP 
Spiritual Economic Physical Social Total 
Male 2 30 6 57 95 
Female 5 k 2 26 37 
This table shows the numerical incidencies of psychological 
stress for the thirty-year-olds and upwards age groups. This consists 
of approximatley 93$ of the total population, 66$ men-and 27$ women. 
Once again, interpersonal relationships are a prime source of psycho¬ 
logical or emotional trouble. 
Many causes can be given by the alcoholic for his insurmountable 
feeling of not being accepted, not experiencing a sense of belonging, 
and the absence of a certain necessary sense of contributing to the 
good of others. The alcoholic, as an intelligent, creative, and sen¬ 
sitive person, seems to have many unmet dependency needs. Eventually 
this state resolves itself into self hatred and at times self-destruc¬ 
tive behavior. All too often the alcoholic is capable of presenting 
an outwardly convincing picture of being normal and highly capable. 
Actually he is a nsick but slick" person who desperately needs the 
understanding and support of family and friends. Perhaps here is 
where the real test of a philosophy of the "human" person can come 
33 
into play. As a human person, the alcoholic can always he accepted 
and respected despite his jeopardus behavior. The person "is good"- 
his behavior "is bad". 
CHAPTER V 
SUMMARY, CONCLUSIONS, RECOMMENDATIONS 
Summary 
The purpose of this study was to determine the existence of 
psychological distress in persons suffering from alcoholism, and to 
indicate the areas where this distress is most evident. The project 
examined only approximately 2% of the alcoholic population, and the 
samples used are not supposed to he representative of the total pop¬ 
ulation. 
The individuals interviewed were quite clear about the existence 
of psychological distress, and the basic conclusion reached by all was 
that their life had become unmanageable. They could not cope with the 
problem of alcoholism without some assistance. The need for profes¬ 
sional help,and ;programs which specifically offer assistance to alco¬ 
holics was clearly evident in all cases. However, each individual 
needed special attention because what was a source of distress for one 
person seemed not so significant to another. 
These findings indicate that specially trained professionals and 
para-professionals are needed to cope with the problem af alcoholism. 
Yet, in-state professional program training, in relation to alcoholism, 
is at a very primitive stage. Physicians, psychiatrists, social 
workers, and nurses have received little adequate instruction or 
35 
clinical experience in this area. There even seems to he a continued 
reluctance on the part of most helping agencies to provide adequate 
care and treatment for problem drinkers and their families. Many pub¬ 
lic welfare departments discriminate against alcoholics. This is seen 
in the way alcoholism is viewed differently than other disabilities. 
If a man were incapacitated for other reasons, he would be declared 
eligible for Disability Assistance. Yet, very few states have such 
provisions, which indicates that many barriers still exist to the pro¬ 
vision and maintenance of proper care, treatment, and rehabilitation 
services for alcoholics. 
While it is held that special treatment is necessary for the 
alcoholic to be able to quit drinking.and start on the road to sobri¬ 
ety, it must be noted that 90$ of recovery takes place in the commun¬ 
ity, and outside of the treatment center.33 Too often it is seen that 
those who take the initial step and "dry out" continue to fall back 
into the clutches of alcohol. It is obviously necessary to examine 
the area that seems to offer most difficulty—the community in which 
the alcoholic must continue to recover.and which provides either posi¬ 
tive or negative motivation. 
It is apparent that a great many people are not knowledgeable 
when it comes to an understanding of alcoholism. Some even feel that 
all an alcoholic has to do is to quit drinking. However, the fact 
that so many victims have tried this and failed must be conclusive 
36 
evidence that something more is required. The best counselors seem to 
insist that continued attention to psychological, emotional, spiritual, 
physical, and economic needs is of vital importance. They believe 
that there is more need for individual counseling, family counseling, 
and groups, such as Alcoholics Anonymous, in our communities. 
The problem of alcohol abuse, alcohol addiction and alcoholism 
is no longer moot. Recognition of the gravity of the situation to 
the point of a national epidemic will have to come from society. An 
informed community is necessary for a variety of reasons. Community 
effort is necessary (a) for any kind of prevention program to be suc¬ 
cessful, (b) to facilitate detoxification and treatment programs, (c) 
to insure that every effort is made to provide the proper atmosphere 
for the recovering patient. This will include reinforcement from the 
individual's personal community. The attitudes and values of the 
community will have a tremendous bearing on the recovery process. The 
beginning of recovery, after the initial desire, will be built on the 
client's assets, not those of anyone else including the counselor. 
However, the patient's frame of reference will surely involve the com¬ 
munity. Dr. Weinberg stresses that "the most effective counseling 
strategy for alcoholics is to reinforce behavior consistent with their 
conventional values. . . unless this is selfdefeating. 
37 
How to get people interested in the problem of alcohol abuse 
might very well be a big factor to consider. The writer believes that 
there is much cause for concern in this area. Alcohol as a drug is 
the first of the sedatives, long since woven into the fabric of our 
society as a legal, social drug. Even prohibition failed to stamp out 
the use of alcohol, and it was proven to be a part of our society and 
our culture by an act of repeal. The use of this drug dates to before 
Christianity. Yet, the ’'disease concept" of alcoholism only began to 
gain moderate acceptance four decades ago. In the last decade, em¬ 
phasis has been directed to the disease as a "primary, progressively 
pathological constitutional reaction to alcohol ingestion,"35 
Another point the author wishes to make is that discussion, re¬ 
lating to the problem of alcohol abuse, might be ignored by society’s 
suspicion. There is no clear idea as to what consitutes the use or 
abuse of alcohol. Because alcohol consumption is so much a part of 
society’s recreational and social life, anything that might threaten 
to interfere with this custom or that might savor of prohibition, 
would be regarded with distain. 
The main reasons why people seem to aVoid treatment seem to 
relate to the fact that people are taught that they must be capable 
of taking care of their own problems, and that they do not need the 
assistance of others. There is a certain stigma attached to those 
who seek social.help. Studies show that even among professionals 
38 
there is a tendency to avoid association with alcoholics. The main 
reasons^given for this is that alcoholics are hopeless or are not 
worth the trouble and that professionals prefer to be dealing with 
more worthwhile projects. In other words, they feel that alcoholics 
are too crummy and weak-willed to be afforded much time. 
The many studies done on alcoholism have proven that many of our 
fondest preconceptions and beliefs about alcoholics are totally false. 
Studies have shown that some common traits can be found among the 
patients: low frustration tolerence, self-punishing behavior, low 
self-esteem, inability to endure anxiety and tension, dependency, 
poor insight, hostility and rebellion, problems in the sexual area, 
sensitiveness, depression, and many others. These can to generally 
characterized as "coping skills". 
With such reported disturbances in the psyche, it is apparent 
that each individual will need different therapy, i.e. training to 
improve coping skills. What kind of therapy and training is required 
for each individual cannot really be decided upon until sobriety has 
been attained and a personality assessment undertaken. To analyze a 
patients’while they are still drinking is usually a waste of time. 
Psychiatrists can analyze the sober patient, provided they recognize 
and treat the addiciton itself. 
Fox enumerates various types of treatment that have had varying 
degrees of success with patients after they have become sober. Some 
39 
of these are Alcoholics Anonymous, Antabuse, Psychoanalysis, Group 
Therapy, Psychodrama, Lysergic Acid Diethylamide, Aversion Treatment, 
Hypnosis, Treatment of Families, and Clergy. 
The aim of therapy of the alcoholic is not only total and'com¬ 
plete sobriety for life but a better functioning in all areas of his 
life—overall increased ability to cope without resorting to abusive 
behavior. An attempt is made to free the alcoholic from a fixed and 
destructive role and to help develop a greater awareness of self, 
a greater flexibility and adaptability, and a greater sense of his 
own potential. When therapy is successful, or when coping ability is 
increased, there is a growing away from the egocentricity of addiction 
to a social sense and an ability to cope with whatever problems life 
may present without resorting to alcoholic oblivion. It is important 
to remember these facts because so many recovering alcoholics are 
apparently satisfied with the fact that they are "dry”.a They fail 
to understand the full meaning of quality sobriety—the learning 
effort that is required. Another social factor that demands atten¬ 
tion is that which deals with companionship and recreation, ive. 
mutual support or life in a supportive environment. Great importance 
surely must be given to this factor, apparently vital in the recovery 
of the alcoholic. When one’s booze and companions are taken away, 
there had better be something to take their place or newly won so¬ 
briety might be in jeopardy. Man is a social being and needs company. 
l+o 
But this is the great North American society and it is extremely dif¬ 
ficult to find friends vho do not drink. Many potential friends or 
companions drink very heavily. Very few people would dream/, of going 
on a fishing trip, a hunting trip, racing, or whatever without making 
provision for a good supply of alcohol. So the pressures are great, 
possibilities are reduced, and certain measures must be taken so that 
a relapse will not be the result. 
Dr. Milam maintains that: all other problems can be traced back 
to the physical disease of alcoholism. He says: "You have to let 
the gross pathology subside and then see what the person really is.'^T 
He also stresses the importance of Alcoholics Anonymous with its dis¬ 
ciplined lifestyle. The author maintains that there is an addictive 
physical disease, meaning that the alcoholic must not drink again, 
and that concommitant factors such as psychological, social, spiritual, 
and economic factors must also be contended with. Therapy is a tre¬ 
mendous help to alcoholics in coping with these pressures, but can¬ 
not be successful if the individual must return to non-supportive 
environment. 
Alcoholics Anonymous has proven to be a wonderful way of life 
for millions of alcoholics as well as the most successful treatment 
program in existence. The central feature of Alcoholics Anonymous 
is provision and ongoing maintenance of an extended mutual support 
system. Alcoholic Anonymous builds the companionship that is 
ill 
necessary. Some alcoholics use other groups, i.e. the Cursillo Move¬ 
ment, Pentecostalism, etc. Of course this depends on the needs and 
orientations of the individual, hut it seems that not many members of 
these groups can share the real problems of the alcoholic. However, 
some have maintained sobriety and found suitable fellowship in this 
way. • • • 
Conclusions 
Alcoholism is the number one health and social problem in the 
United States and as such deserves a concerted public effort towards 
its prevention and alleviation. Until very recently, little under¬ 
standing or concern was accorded the deplorable plight of millions of 
Americans, but with continued medical and psychosocial research and 
study, an imposing backlog of reference books, pamphlets, magazines, 
etc., are now available. Much misinformation, as well as "labels" 
and spurious philosophies, can be put to rest. A growing number of 
scientific and professional studies have definitely proven that alco¬ 
holism is a disease. The alcoholic, a victim of a chemophysical con¬ 
ditioning, must be helped to understand this. The general public 
must be led to acquire this truth and to henceforth desist from mor¬ 
alizing or stereotyping, 
In a less scientific way but with esoteric clarity, this survey 
indicates that psychological distress due to alcohol addiction invades 
k2 
the human personality and distorts the ability to reason, to judge, to 
choose. What a waste of human talent, since each person happens only 
once in all the history of mankind! 
1. There is no definite information as to just how persons 
really recover from alcoholism. Even the wisest counselors and thera¬ 
pists have no specific treatment but a multi-dimensional morality. 
But, everyone agrees that once the drug has been removed, there must 
be something real and authentic put in its place. A supportive, pos¬ 
itively motivating environment must provide some sense of personal 
meaning, some sense of personal worth and some personal purpose in 
living! Above all, there must be lots and lots of hope! 
2. Very little can be done in the way of setting up adequate 
programs for alcoholics and their families until such time as the 
public gives its full support,and until sufficient funding is made 
available. There is no doubt that funds can be found if the true ex¬ 
tent of the problem can be demonstrated. An article from the Seattle 
Post-Intelligencer, May 13, 1976, shows that the amount of taxes on 
a fifth of distilled spirits amounts to $3.1*9 as it reaches the shelve 
of the customer. The federal and state governments that maintain this 
monopoly on addiction can well afford to kick back more then enough 
money to provide for the abundant care which the alcoholic and all 
those affected by the consumption of booze badly need. 
1+3 
3. This study has shown that possible solutions will require 
the good-will and skills of many people—professionals, para-profes- 
sionals, and people of influence. Much training is needed so that 
more people can understand how complicated, and far-reaching the pro¬ 
blem of alcoholism is. Courses are needed in Montana’s colleges and 
universities, taught by knowledgeable people, so that Montana’s stu¬ 
dents will receive proper information instead of the mess of misinfor¬ 
mation they have been receiving. 
It appears that what we have at the moment is a lack of recog¬ 
nition of root problems as well as a poor effort to solve our problems 
The situation will remain so unless our concerned people are given a 
voice. Wonderful work has been accomplished by individuals such as 
Senator Harold Hughes, Senator Lawrence Fasbender in Montana, anon¬ 
ymous members of such groups as Alcoholics Anonymous, and many members 
of large companies in the country. 
Recommendations 
As a result of this study it is recommended: 
1. Separate treatment facilities for social classes be estab¬ 
lished. Cascade County seems to avoid, or overlook, possible diffi¬ 
culties that have arisen in other states regarding appropriate treat¬ 
ment facilities. In particular, attention must be given to the 
distinction that must be made between patients who are supported by 
kk 
means of Public Assistance and those who can afford to pay their own 
expenses or who could be covered by insurance companies. Other states 
have made this distinction with much success, and it seems that the 
same policy would be suitable in Montana. 
There is also a possibility that middle class people are more 
concerned with private treatment centers or out-patient programs than 
lower class people. We know that the disease is the same, at least 
physically, but perhaps the paying customer will manifest a greater 
sense of pride. Public Assistance patients will be less concerned 
about anonymity; they will also probably require different kinds of 
treatment and perhaps be helped more with regard to rehabilitation 
and training for future."jobs. 
2. More research into the best methods for treating members of 
ethnic minority members is needed. Some will be better served by 
members of their own ethnic groups; others might respond better to 
whites, especially if they have been raised by whites or if they seek 
to break through the race barrier. 
3. The female alcoholic deserves very special attention. Women 
alcoholics are extremely effected by social sanctions and deserve 
special treatment. More research is necessary to discover what poss¬ 
ible kinds of treatment facilities are most suitable to women, and 
how individuals are possibly different. 
4. A model developed along this line would be helpful for de¬ 
pendency prone persons: 
A. Pre-requisites of program: 
1. Treatment should differ along continuum—from minimal to 
maximal intervention. 
2. Treatment modality provides for sequential steps—no frag¬ 
mentation or non-siquitur approaches. 
3. Any and all services should be adequate to meet the needs 
of individual persons—use differential diagnosis for 
differential treatment. Professional screening. 
4. Motivational counseling which seeks out dependency prone 
persons and encourages, . .persuades. . . coerces (if 
necessary). Client needs ’’fit” to specific treatment 
modality. 
5. Detoxification as pre-requisite for any type of assistance. 
B. Operation profile; background data on resident or out-reach 
person: 
1. Completion of questionnaire adapted to agency or center. 
2. Personal perception of problem—the client's world; what 
behavior put client in jeopardy. 
3. Situations and circumstances of drinking—what were some 
symptomatic behaviors? 
h. Patterns of drinking; sub-populations. 
5. Motivational level—previous attempts at adjustment; 
awareness of personal and social needs. 
C. Multi-variate treatment modalities: 
1. Information: 
a. drug usage 
46 
Information (con’t,} 
b. dependency addiction 
2. Educational: 
a. community resources 
b. volunteer services 
c. alternates to drinking 
3. Psychotherapeutic: 
a. one-to-one and/or group 
b. ego therapy; self fulfillment; self affiliation 
c. testing—Taylor-Johnson Temperament, California 
Psychological Inventory, Works Value Inventory, etc. 
d. transactional analysis 
e. transcendental meditation 
f. assertion training 
g. encounter—light to heavy 
h. team—group involvement; primary and secondary sociali 
zation 
4. Holding Programs: 
a. day care 
b. . after care 
c. half-j-way houses for couples, families, single persons 
d. cottage plan 
e. Alcoholics Anonymous 
1+7 
5. Reality adjustment: 
a. immediate goals 
b. long range goals 
c. -social milieu: family, parish; community—see that 
these give support and not seduce recovery. 
D. Criteria for treatment outcomes: 
1. Abstinence is the ONLY real criteria. 
2. Change must be built-in core of therapy: 
a. change in attitudes towards self 
b. change in interpersonal relationships 
c. change in physical health hhbits 
d. change in vocational functioning—no dependency-prone 
person is dysfunctional in all areas! 
3. Specific need-changes are geared to specific treatment 
modality. i 
E. Prevention: Is anyone preventing??? 
1. Education at all levels: 
a. institutions 
b. state 
c. business 
d. schools 
e. community 
f. families 
1+8 
2. Consultation: Professionals and para-professional speci¬ 
fically trained. 
a. philosophers 
h. social workers 
c. psychologists 
d. group workers 
e. psycho-metric technicians 
f. communication experts 
g. teachers 
h. tutors 
3. Community Organization:. Any program of primary prevention 
must be practical, realistic, and related to the social 
structure in which it operates. Its goals must be seen to 
have a reasonable chance of success so those for whom the 
message is intended will be receptive and not dismiss it 
as irrelevant or unrealistic. 
F. Scorn alcohol not alcoholism!! 
SELECTED REFERENCES 
REFERENCES CITED 
1. Keller, M., A Dictionary of Words About Alcohol. Nev Brunswick, 
N. J.: Rutgers Center of Alcohol Studies, 1968. 
2. Alcohol and Health, U. S. Department of Health, Education and 
Welfare, June, 197^» pp. x-xi. 
3. North Central Montana Areawide Health Plan, k2k Main Street, 
Shelby, Montana, 1975» p. 109. 
1+. Petersen, Donald H,, ’’Disease Concepts of Addictive Disorders,” 
First North American Conference on Halfway House Alcoholism 
Programs, Granville House, Inc., St. Paul, Minnesota, June, 
19^o, p. 20. 
5. North Central Montana Areawide Health Plan, op. cit., p. 123. 
6. Cascade County Alcoholism Services Project, 920 5th Avenue North, 
Great Falls, Montana. 
7. University of Arizona Bulletin, Tuscon Arizona, 1976. 
8. Keller, Mark, ’’Alcoholism: Nature and Extent of the Problem,” 
Understanding Alcoholism, Annual of the American Academy of 
Political Social Science, 1958, 315:1. 
9. Milt, Harry, Basic Handbook on Alcoholism, Scientific Aids Publi¬ 
cation, Maplewood, N. J., 1971* p. 28 
10. Code of Laws of the United States of America, Sec. 221, Title 21. 
11. Montana State.Plan for Alcoholism and Alcohol Abuse, 1975, State 
Capitol, Helena, p. 22. 
12. Ibid, p. 19. 
13. American Medical Association, Manual on Alcoholism, Chicago, 
Illinois, 1967. p. 2 
14. Steed, Ernest H., The Answer to Alcoholism, Narcotics Education, 
Inc., Review and Herald Publishing Association, Washington, 
D. C., p, 20. 
51 
15. Ibid, p, 37. 
16. Powdermaker, Florence, The Relation Between the Alcoholic and 
the Physician, Quarterly Journal of Studies on Alcohol, 
Rutgers Center of Alcohol Studies, New Brunswick, N. J., 
September, 19^> 245-1+8. 
17. Petersen, Donald, op, cit,, p. 20. 
18. Middleton, J. W., A Feasibility Study for the Analysis of Econo¬ 
mic Factors Associated with the Hospital Treatment of 
Patients Who Are Also Problem Drinkers, Department of Commun^b 
ity Medicine, University of Kentucky, Lexington, Kentucky, 
PERT Project No. 2-B, 1971. 
19. Petersen, Donald, op. cit., p. 21. 
20. Plaut, Thomas F., Alcohol Problems: A Report to the Nation by 
the Cooperative Commission on the Study of Alcoholism, 
New York, Oxford University Press, 1967. 
21. Ullman, Albert D., Attitudes and Drinking Customs, In: Mental 
Health Aspects of Alcohol Education, Washington, D. C., U. S, 
Public Health Service, 1958. 
22. Montana State Plan for Alcoholism and Alcohol Abuse, op. cit., r 
p. 3. 
23. Maddox, George L., and McCall, Bevode C., Drinking Among Teen¬ 
agers , New Brunswick, N. J., Monograph No. 4, Rutgers Center 
of Alcohol Studies, 1964. 
24. Cross, Jay N., Guide to the Community Control of Alcoholism, The 
American Public Health Association, N. W., Washington, D. C., 
1972, p. 33. 
25. North Central Montana Areawide Health Plan,.,op. cit., pp. 102- 
108. 
26. The Cascade Council on Alcoholism, Application for Indian Grant 
for Providence Resocialization Treatment Center, June 20, 
1974, 920 5th Avenue North, Great Falls, Montana, 
52 
27. Situation Statement, Cascade County, Montana, 1972, p. 6. 
28. Montana State Plan for Alcoholism and Alcohol Abuse, op. cit., 
. pT% 
29. Situation Statement, op, cit,, p. 8. 
30. North Central Montana Areavide Health Plan., op. cit., p. 123. 
31. Kruse, H. D., Alcoholism as a Medical Problem, Medical Book 
Department of Harper and Brothers, New York, N, Y., 1956, 
P. 37. 
32. Kruse, H. D., op, cit,, p, 37. 
33. M. (Weisser) Mantell Chart - adapted from R. G. Bell, 
3I+. Weinberg, Jon, Director Education and Training, Hennepin County 
Alcoholism and Inebriety Program; Minneapolis, Minnesota, 
Counseling Recovering Alcoholics. 
35. Milam, James, Emergent Comprehensive Concept of Alcoholism, 
Treatment Center of Alcenas, Seattle, Washington, 1976, 
36. Fox, Ruth, A Multidisciplinary Approach to the Treatment of 
Alcoholism, American Journal of Psychiatry, Vol. 123, 
January, 1967* pp. 769-778. 
37. Milan, James, op. cit,.