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Bad Reflection. Some experts believe that alcoholism may be encouraged by the destruction of traditional values. Buttressing this notion is the experience of the American Indians and Eskimos, whose cultures have been disrupted more than those of any other ethnic groups on the continent. "The major problem is one of social disintegration," says Dr. Charles Hudson, chief of psychiatric services at the U.S. Public Health Service's Alaska Native Medical Center. "The original social structure in many places in rural Alaska has been blown apart, much as it has been in central cities, the ghettos and Appalachia. The things that were important to people have been taken away, and when there's nothing to do, they'll take their last buck to get a bottle and stay drunk all the time."
Blacks and Chicanos are also particularly prone to alcoholism, possibly for similar reasons. Among whites, the Irish Americans probably rank highest on the alcoholic scale. No one can explain precisely why, although Irish American social life has often centered around the pub or bar, and heavy drinking has been a culturally accepted means for temporarily getting away from problems. Jews, by contrast, have a relatively low incidence of alcoholism, though it is rising among them too. Jews have always frowned on public drunkenness as being a bad reflection on their entire culture, and drinking has not been the accepted way to relieve problems ("Jews eat when they have problems," quips one Jewish psychiatrist in Manhattan).
Although alcoholism, when it occurs, often follows ten years or so of problem drinking, there are also alcoholics who apparently skipped even the social-drinker phase. They passed from total abstinence directly into chronic alcoholism. This may be due in some cases to a biochemical imbalance of some sort. "There have been people I call 'instant alcoholics' who are in trouble the minute they drink," says Marty Mann.
There may be some yet unknown hereditary factor that fosters alcoholism. Dr. Donald Goodwin, a psychiatrist at Washington University in St. Louis, studied the case histories of 133 Scandinavian men who had been separated from their natural parents and raised by foster parents. The sons of alcoholic fathers were four times as likely as the sons of nonalcoholics to be alcoholics themselves. Similar studies by Goodwin of twins raised by different families seem to offer even stronger support for some genetic explanation. Most researchers are reluctant to accept such biological determinism as the sole cause, but many agree with Goodwin that there may very well be some errant gene that makes at least some alcoholics more vulnerable than the rest of humankind to the bottle.
"There is no one overall answer," concludes Don Cahalan. "We are trying to exorcise a devil, but there is no one devil. There is a host of demons."
There is also a host of treatment centers—7,500 by latest count—and treatments. Until recently, alcoholics were thought to be all but incurable, afflicted with a kind of psychic leprosy.