In a purely physical sense, alcohol intoxication can be considered to be an across the board incapacitation of normal brain function. Depending on the degree of intoxication, people have difficulty speaking clearly, accomplishing tasks like driving and walking, thinking, remembering and committing new experience to memory. The desire for this disruption of normal mental processes is at the heart of both social drinking and alcoholism.
While there are specific pharmacological effects of alcohol that contribute to social and alcoholic drinking, these are of little relative importance except as a general backdrop for expectancy effects. This is demonstrated in a rather humorous anthropological study done among the natives of the Truk Islands in Polynesia.137
Young males, not knowing one must drink alcohol to get drunk, became “intoxicated” by sniffing an empty bottle. They “lost control” of their behavior because they knew from seeing drunken outsiders what happened when people got drunk.
Because they were intoxicated, the village elders declined to punish them. Obviously the behavior was attributable to the alcohol, not the young men.
While this may seem extremely far fetched, there is ample concrete evidence that what is believed about the effects of alcohol, or other drugs, to a very large extent overrides the actual physiological effects of the chemical in terms of behavior and subjective experience.
In a study using hypnosis with heroin addicts, experimenters were able to produce, by suggestion, a drug “high” in their subjects complete with physiological changes such as altered pupil size and blood pressure.138 They also produced the withdrawal state by suggestion. The subjects, when actually given drugs and drug counteracting posthypnotic suggestion, behaved normally. In other words, people can become, for all practical purposes, high on drugs and go through withdrawal from those drugs without ever taking them. They can also behave as though not high when actually on drugs.
the balanced placebo design
A special method called the balanced placebo design has been necessary to determine the effects of alcohol itself as opposed to the effects of believing that alcohol has certain effects. Subjects are divided into two groups. One group is led to expect that they are drinking alcohol. The other is led to expect that they aren’t. Every effort is made to build expectancy, such as mixing the drinks in front of the subjects and demonstrating false “breathalizer” results. Both groups are divided in half again. Half of each group is actually given alcohol and half not. The four groups are:
1) believe alcohol, given alcohol
2) believe alcohol, given no alcohol
3) believe no alcohol, given alcohol
4) believe no alcohol, given no alcohol
Use of this experimental design has disproved many widely held beliefs thought proven in earlier experimentation. Among these beliefs about alcohol is that alcohol causes sexual arousal.
sex, alcohol, and the balanced placebo design
In a study with the balanced placebo design, male social drinkers were divided into the four groups listed above.139 The subjects were wired to equipment which measured several factors in sexual arousal including penile tumescence, heart rate and skin temperature. After drinking, the subjects listened to tape recordings of heterosexual intercourse, forcible rape and nonsexual sadistic aggression. The two groups who believed they had drunk alcohol were more aroused by the rape and sadism tapes than the other two groups. Belief, not actual alcohol consumption, was the deciding factor.
Another experiment with the balanced placebo design used “dirty pictures” of varying types; some “deviant” and some “normal.”140 The subjects were timed on how long they spent looking at the individual pictures. Those who believed they had been drinking alcohol, as a group, looked at the “deviant” pictures longer. In other data gathered from the subjects, it was found that only those who had a high level of sexual guilt were affected by the belief they were drinking. This indicates that, rather than alcohol “unleashing perverted sexuality,” the belief one has been drinking counteracts sexual guilt.
The main effect of alcohol on human sexuality is to decrease physiological response. But, believing one has been drinking more than counteracts decreased physiological sexual response by “giving permission” or “displacing responsibility” for one’s behavior from oneself to the alcohol.
aggression, alcohol, and the balanced placebo design
The belief that alcohol causes aggressive behavior is also widely held. In another experiment with a balanced placebo design, experimenters found,
"The only significant determinant of aggression was the expectation factor. Subjects who believed they had consumed alcohol were more aggressive than subjects who believed they had consumed a nonalcoholic beverage, regardless of the actual alcohol content of the drinks administered.”141
Another study found that those who believed alcohol increased aggression were more aggressive when they thought they were drinking. This held true even after taking into consideration how hostile the subjects were to begin with. In other words, no matter how hostile a person may or may not be, if he believes drinking will make him more aggressive, he will be more aggressive if he thinks he is drinking.
The effect of expectancy on behavior when drinking is profoundly highlighted in different South American Indian tribes. Different tribes have different attitudes and beliefs which govern their drinking behavior. One tribe may use alcohol strictly on religious occasions. In a religious ceremony, the priest may get so drunk he needs help standing up. However, nothing detracts from the completion of his priestly duties. There is neither aggressiveness or licentiousness. No behavior is expected to detract from the spiritual nature of the occasion. None does.
A few miles away, another tribe, with more outside influence, may become rowdy when drinking at a nearby cantina. Another nearby tribe may combine the two, behaving piously when drunk at religious ceremonies and losing all restraint on social occasions.
the attraction to alcohol in our culture
The general attraction of alcohol in our culture is heavily based on its use as a “social lubricant.” Alcohol, like Valium, the barbiturates and certain other drugs, is an anti anxiety agent.142 It decreases certain types of fear such as fear of failure, punishment and frustration. A drink or two will lessen or remove the little fears which inhibit social interaction. For example, if someone is a little afraid of striking up a conversation with a stranger because they are somewhat worried about rejection or “saying something stupid,” alcohol will weaken the fear and allow spontaneous interaction. Alcohol also narrows awareness in general and decreases self awareness.*1 For instance, the attention of a partygoer is apt to be narrowly focused on the party. The frustrations of the workday, worries about tomorrow and awareness of the self fade away as attention is narrowed to the competing music, conversation and food. This is the core of the expectations and goals of social drinkers.143
the benefits of heavy drinking
There is no one reason some people see benefit to drinking excessively over other excessive behaviors. In the following paragraphs some of the more common perceived benefits of drinking are presented. The degree that the benefits of alcohol are only perceived benefits and fail to fill real needs is the degree to which alcohol use is a problem. For example, the light social drinker seeks only a moderate amount of disinhibition and “euphoria” from alcohol and only on certain occasions. He generally gets exactly what he expects. He is also likely to expect that alcohol will intensify all feelings, pleasant as well as unpleasant.
Heavy drinkers, on the other hand, perceive great benefit in drinking to excess. Unlike social drinkers who tend to expect alcohol to intensify whatever they feel, alcoholics commonly expect to feel better no matter how they feel.144 Under such expectations, the worse one feels the more reason one has to drink. If a heavy drinker is fighting the emergence of unpleasant feelings of enough intensity and persistence, he may drink so much his friends will have to tell him the next day how much fun he had.
Drinking to dull the awareness of undesired feelings does nothing to remove the cause of those feelings. A woman who drinks to suppress feelings of anger or jealousy over a suspicion her husband is having an affair will never, by drinking, find out if her suspicions are justified and appropriately deal with the situation. Instead, she may keep her suspicions, anger and jealousy in perpetuity. She would have “a need” to drink many times over one situation.
Drinking alcohol can also be a way of temporarily evading internal restrictions. People “know” alcohol causes aggressive, hostile behavior. Since “the alcohol causes it,” a mild mannered gentleman who never has an unkind word for anyone can, by getting drunk, give vent to his hostility. Everyone, including himself, “knows” he would never act that way; it was the alcohol. He preserves his self image. Alcohol serves a “useful” function.
Everyone “knows” that alcohol decreases inhibition and breaks down resistance to sexual advances in women, “Candy is dandy but liquor is quicker.” With this knowledge, a prim and proper lady who would never be sexually seduced can be seduced into drinking and, the next morning when she wakes up in a strange bed, can tell herself, “I shouldn’t have drunk so much. Look what happened to me.” She knows she isn’t a “loose woman.” It wouldn’t have happened if it wasn’t for the alcohol.
It must be made clear that because of alcohol’s scrambling of normal mental function, it is possible someone will be extremely aggressive or promiscuous due in part to the effects of alcohol one time. The issue here is not the spurious, one time, “freak” incident but the continual repetition of the same behavior.
The point in these two instances is not that people consciously set out to use alcohol as an excuse but that people who have been taught to deny vast areas of their own existence easily fall into a further trap. They come to attribute their own power and their own choices to external forces. For instance, the man who repeatedly gets drunk and beats his wife or the woman who gets drunk and “is taken advantage of” every Saturday night will ruefully blame the alcohol and swear never to drink again. However, no matter how sincere, neither is likely to keep their promise.
They will try to be good in early childhood terms. They will work to keep their mental function disrupted. The angry and abusive man will try not to feel angry, the promiscuous woman will try not to feel lonely. Against the certainty he or she will become angry or lonely, alcohol may seem a “good” solution. Alcohol may come to be “automatically” seen as the solution. The more incapacitated mental function is, the easier it is to be “good.” Even if failures occur, like becoming abusive or promiscuous, it can’t be helped, “the alcohol was responsible.” It is a better choice to risk becoming abusive or promiscuous than facing the certainty that anger or loneliness will reappear and no one but oneself is to blame.
By considering emotions the problem and believing that drowning them is the best possible choice, it is unlikely the proper associations will be made. The hostile man may never know the real causes of his anger or productive ways of expressing it. The promiscuous woman may never recognize her loneliness and find methods of relating to men that are more honest and more consistent with her values.
Repressed anger and intimacy problems often play a role in alcoholic drinking. However, the “misbehavior” is usually much more associated with temporary and increasingly futile attempts to escape from learned internal rules and regulations.
These internal restrictions are ones that other people simply do not have as opposed to “society’s rules.” For example, if someone has been taught they don’t deserve to be happy, they can break the rule and be “happy” by becoming drunk. The anti anxiety effects of alcohol decrease the fear of punishment and the alcohol can be blamed. If someone has learned to stifle their spontaneity, by being drunk, they have internal permission to be spontaneous. Again, the alcohol is responsible, not the person.
If someone is taught in childhood that he doesn’t deserve to be happy, but to be punished, he can temporarily evade the injunction by getting uproariously drunk and having a good time, then spend the next day “making things right” by suffering a hangover.
Alcohol has many perceived benefits for heavy drinkers other than permission, or as an excuse, for “misbehavior.” People who have been led to believe they are incompetent and fear the possibility of exposure, particularly to themselves, can use alcohol as protection from the feared “truth.”145 For example, someone who fears he is incompetent in the business world may prefer to risk causing failure by drinking too much rather than face the fear that he may indeed be incapable. It is a perverse kind of win win situation. If he fails he can blame the drinking. If he succeeds, he can give himself “extra credit” because it was so much more difficult with the handicap. For the serious self handicapper, there is almost no limit to the variations of this method which can be used. It can be used at work, at play and in relationships.
Perhaps the biggest motivation for excessive drinking is to cope with “negative” emotional states. Alcoholics and addicts of all types see the internal experience of emotion, as well as other integral parts of the self, as bad. The “solution” is to keep the offending emotions out of awareness.
study: being provoked to anger without possibility of retaliation
At times when “bad” emotions are subject to be aroused, alcohol consumption increases. One interesting study investigated “heavy social drinkers”146 who were provoked to anger with and without an opportunity to retaliate.*2 The sixty drinkers were intentionally provoked to anger with insults about their intelligence, way of dressing and general appearance. Under the guise of a wine tasting test, it was found that those who had no chance to “retaliate” drank significantly more. Imagine the effect on someone who learned in early childhood to never be angry. Without even the internal experience of anger “retaliation,” or even response, is impossible. Imagine the effect on drinking in daily life.
study: drinking in response to fear of being evaluated
Another experiment with “heavy social drinkers” tested whether fear of being evaluated led to increased drinking.147 Sixty four male college students participated under the guise of a wine tasting experiment. Thirty two were led to believe they would be in a second experiment where they would be personally evaluated by a group of women. Needless to say, for a young college man this tended to be a rather intimidating prospect. Those who expected the evaluation drank considerably more than the other group.
In everyday life, people are constantly evaluated when meeting new acquaintances, applying for a job or on a first date. Imagine the intense fear generated and the corresponding increase in alcohol consumption of someone who has been taught, and is “keeping the secret,” that they are basically “unfit for survival,” “unlovable” and “inherently defective.”
A review of the literature on expectancy and drinking behavior148 cites studies dating back to 1945 about the use of alcohol in relation to issues of personal power. The studies show that alcohol consumption increases in situations where a person feels powerless or incapable. In our culture, people often expect and therefore often experience, a feeling of power or control when drinking. For someone who’s life is pervaded with learned helplessness and is in a constant battle to keep feelings of powerlessness out of awareness, alcohol has great attraction.
Problem drinkers don’t consider emotions a helpful source of information. It would be unusual for an alcoholic to appreciate his feelings of sadness, loneliness, anger or helplessness. Even if he should get a glimpse of the meaning and purpose behind them, having learned he is helpless in important areas of his life, he is unlikely to work to solve the problem behind those feelings. Instead, he takes direct action to make the feelings go away. Alcohol is a “useful tool” in this endeavor.
For those who have problems with intimacy, alcohol has much to offer in terms of image if not in substance. Alcohol sales campaigns often associate alcohol with “good times” and “warm intimacy.” The alcoholic beverage industry sells its product in advertisements which usually feature either a couple in a romantic setting or a larger group of people enjoying “good times and friendship.” People who drink are never, of course, portrayed as lonely social misfits. Our cultural association of alcohol with both sexual and emotional intimacy and enjoyable social interaction is not lost on the alcoholic.
Normally, someone who later becomes a “problem drinker” begins and maintains drinking on a predominately “social” level for years. The problem develops gradually. For the person whose self hatred allows only shallow interaction with other people the image of alcohol becomes confused with the reality of intimacy. As frustration increases over the inability to fill human needs for emotionally fulfilling relationships, alcohol offers itself as a symbolic substitute. People who give up excessive drinking or drug use often describe it in terms of giving up a lover or best friend.
Heavy drinking can also be seen as an attempt to be good in early childhood terms. Its main physiological effect, the disruption of mental function with a resultant decrease in both self and general awareness, matches many problem drinkers’ early childhood lessons of how he should be.
Cultural beliefs about alcohol build the expectancy that alcohol has magical powers to cause behavior totally separate from a person’s identity. This allows a person to engage in behaviors that would normally be restrained as contradictory to self image. This dual attraction of heavy drinking can become an ever more attractive solution to life.
As use increases, real problems tend to get worse. As problems get worse, the subconscious struggles harder for attention, meaning it works to generate more intense emotion. If the subconscious learns the solution to problems is to drink, what is perceived as an alien force begins to impel a person to ever more self destructive drinking.
moderation and abstention
There is nothing irrevocable about the addiction process. Tens of millions have quit smoking, a large percentage of overweight people have managed to attain and maintain a desired weight and an estimated two or three percent of alcoholics “go into remission” every year. The reason for these changes varies with the person. Younger substance abusers generally give up their habits as they grow older. It is seen as inconsistent with an adult role as husband or wife and father or mother.
Often, altered circumstances lead to the change. Someone who drinks due to frustration over not being able to find suitable work may promptly moderate upon finding a new job. Someone who drinks due to the loss of a spouse through death or divorce may moderate or quit when they begin to date. Often alcoholics will quit or moderate when they develop a physical intolerance to drinking. It is extremely difficult to keep up a pattern of heavy drinking if the first drink causes sharp stomach pains and the second one makes things worse.
A deep awareness that drinking is not the best choice is what precipitates change. It can take many forms from one morning looking in the mirror and thinking “Why am I doing this? This is not what I want to do,” to waking up in a hospital after an accidental overdose and becoming aware that, “I will die if I continue this way.”
The deep awareness which often precipitates a change in drinking patterns takes two general forms; a moment of clarity or a painful emotional ordeal. AA members aptly use the term “hitting bottom” to describe the tumultuous emotional ordeal precipitating a desire to change. The “moment of clarity” is often cast in “spiritual” terms and ascribed to an awareness of AA’s Higher Power.
These deep awarenesses must be distinguished from “shallow“ ones. A conscious, surface decision to change that doesn’t reach to the depth of the subconscious decisions to drink will leave them unaffected and the drinking behavior “on automatic.” A person who internally experiences an inability to stop drinking may be out of touch with the reasons he drinks, have learned he is helpless so his subconscious automatically fails to muster resources for the effort or uses “not being able to stop” as a way of protecting his self image from the knowledge that he wants to drink
However the decision to change develops and is experienced, it may be only the beginning of a protracted process. The addicted person has the job of finding new ways of filling, or trying to fill, his needs. This often takes the form of substituting other addictions. With the blessings, assistance and encouragement of their psychiatrists, drinkers often substitute Valium, Xanax or other anti anxiety drugs for the alcohol. Abstinent alcoholics often smoke more cigarettes and drink more coffee. Religious or sexual addictions are often substituted or come to the forefront.
Most people who have drinking problems want to moderate their drinking rather than quit altogether. Disease theorists and AA members consider this to be a symptom of the disease, “denial.” While there may be a lot of denial on the subject of controlled drinking, the denial seems to be more a characteristic of the disease theorists and AA members. The truth of the matter is that, even after treatment that works to sabotage the ability to moderate, almost three times as many alcoholics do manage to moderate their drinking as manage to abstain.149
Treatment sabotages the ability to moderate by instilling AA’s “One drink, one drunk” belief in those who already have drinking problems.150 This is teaching learned helplessness. When people learn they can’t help but continue drinking, the subconscious automatically fails to marshall the resources to stop. Also, if someone wants to get drunk they can “accidentally” or “unwittingly” eat rum cake, use mouthwash or take a sip out of the “wrong glass.” By placing the blame on the alcohol and “innocent action,” an “alcoholic” gets to get drunk and preserve his self image. The alcohol is responsible, not the person.
Some excellent studies have compared the benefits of abstinence and “controlled drinking” as goals of treatment. One of these151 involved 70 alcoholics who, in order to qualify for the study, must have met certain conditions. They must not have been AA members, must not have believed in the disease theory and must not have been able to manage an extended period of abstinence. The seventy were randomly assigned to one of two groups; one with the goal of abstinence, the other with the goal of moderation. After treatment they were followed for two years. The findings strongly support moderation as a goal over abstinence.
Most of those assigned to the abstinence group objected to the goal. During treatment, those assigned to abstinence drank more than those in the controlled drinking group. During the two year follow up, both groups drank the same in both quantity and frequency. An important point is that most of those assigned to abstinence moderated on their own. Perhaps most important is that while those who were classified as “lighter” drinkers did equally as well in both groups, those classified as “heavier” drinkers did better with controlled drinking treatment.
Of course, abstinence is necessary for some people. People with health problems such as liver damage and diabetes must abstain. This is not because one drink inevitably leads to the next but because one drink is injurious to an already ailing body. Abstinence is also clearly necessary for those who believe “One drink, one drunk,” because for those who believe it, one drink, or perhaps even using mouthwash, does lead to one drunk.
This discussion of the merits of abstinence is not intended to suggest that people who are successfully abstaining should drink. The point is that for most problem drinkers, abstinence is an unrealistic goal. The “loss of control” hypothesis used to support a need for abstinence for “alcoholics” has been proved untrue. The person with drinking problems who wants to moderate his drinking, and hasn’t been convinced he can’t, in all likelihood will succeed. The situation is entirely different for people with heavy exposure to AA. They almost never moderate. As a matter of fact, practicing AA’s “spiritual principles” usually makes the underlying problems of alcoholics and addicts much worse…