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Certain ethnic groups, Vaillant found, are collectively maladaptive. Irish men in the study generally grew up in families where alcohol was forbidden, drinking took place apart from meals and away from home, and male drunkenness was tacitly admired. The Irish in the survey also became alcohol dependent seven times as frequently as the Italians, who as children learned that drunkenness was frowned on and drank with family groups and with meals (thus diminishing the addictive effect of the alcohol "high"). To Vaillant, these sharp differences (which are also true of the more alcoholic Northern Europeans as contrasted to moderate Jews) suggest that "one of the directions we should go is to teach children how to make intelligent drinking decisions." Vaillant, a social drinker, serves wine to his children, Anne, 16, and Henry, 17, on ceremonial occasions.
The high number of children of alcoholics who become addicted, Vaillant believes, is due less to biological factors than to poor role models. Being raised in a warm, close-knit family does not lessen a child's chances of becoming an alcoholic, nor does coming from a family with many problems increase the risk. Vaillant is reluctant to make predictions about behavior, but believes that the best sign that a child may not develop into an alcoholic as an adult is an "ineffable" quality—ego strength—that seems to come from experiencing a sense of competence when the person is young.
The hottest argument among experts on alcoholism these days is over whether an alcoholic can ever again return to social drinking without inevitably suffering a relapse. Vaillant, who constantly repeats that alcoholism is a problem that can be described only in grays, not in black or white, says that it all depends on how sick the alcoholic is: "If you have a little bit of alcoholism, as if you have a little bit of diabetes, you can control it." But Vaillant warns, "By the time a clinician identifies a person as an alcoholic, it's almost always too late to return to social drinking." On this issue, Vaillant is supported by the National Council on Alcoholism. Says Dr. Sheila Blume, medical director of the N.C.A.: "The alcohol-dependent or loss-of-control alcoholic is not able to return to drinking."
Dr. John Wallace, director of Edgehill Newport, a 165-bed alcohol-treatment program in Newport, R.I., says flatly that the suggestion that an alcoholic might be able to return to social drinking safely is "a serious ethical problem, because at least 97% of alcoholics, if you let them drink, could die."