The Glass Half Empty

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New York Times Magazine, May 9, 1999


"Valley Of The Dolls" still from Photofest

ALCOHOL IN AMERICA: DATA

Since 1977, per capita consumption of alcohol in the U.S. has dropped 17 percent. Beer consumption is down a few percentage points, wine has stayed about the same and hard-alcohol is off by 39.6 percent.

Beer is the most popular alcoholic beverage. The typical American drinks 32 gallons of it a year (nearly one 12-ounce can a day), which makes it the nation's fourth most popular beverage (trailing soft drinks, coffee and milk).

According to The Journal of Substance Abuse, 44 percent of American adults are drinkers, 22 percent are former drinkers and 34 percent are lifetime teetotalers.

Nearly 14 million adult Americans have alcohol-abuse problems. Alcohol abuse figures in half of American homicides and about a third of suicides.



The Glass Half Empty

It's easy to scoff at the notion that alcoholics can be cured with a pill. Maybe because we don't think they deserve to be . . .

By CAROLINE KNAPP
Author of DRINKING: A LOVE STORY and PACK OF TWO

My approach to well-being, circa 1990: Scotch, chardonnay. Very direct, very effective.

My approach today: A.A., Zoloft, therapy, exercise, relationships. Very elusive, hard to maintain, but ultimately more rewarding.

A new approach, coming soon to a pharmacy near you: Antiaddiction drugs, designed to tamper with the circuitry of dependence. Efficacy as yet unknown.

The neuroscientists are at it again.

Having already amassed a sizable arsenal of drugs against miseries like depression and obsessionality, researchers have turned to the battlefront of chemical dependence. Drugs with names like Naltrexone and Campral, which diminish the highs of substance abuse and dampen the cravings of withdrawal, are on the market or are soon to be. Before long, we may well have pharmaceuticals that mop up cocaine before it hits the brain, even drugs that trigger the body's immune system to produce antibodies against addictive substances.

Drugs to get us off drugs? Just imagine -- a generation of Americans trading in martinis for meds, swapping dependencies like baseball cards, bantering at cocktail parties in the new millennium: "Alcohol? How 20th century! Forget the Campari -- bring me a Campral!"

Such scenarios are fun and easy to indulge in, in part because it's so tempting to overstate the promise of drugs, to see them as neurological superheroes, poised like Prozac to swoop down and rescue us from the jaws of addiction. The idea, of course, is as illusory as it is seductive.

Having been desperate enough to quit drinking five years ago -- and scared, willing and lucky enough to stay that way -- I don't put much stock in magic bullets.

I tend to believe that recovery is, as the expression goes, an "inside job," a matter not just of switching off the urge to drink or take drugs but also of understanding and addressing the feelings behind that urge.

This is one reason recidivism rates among addicts are so high: getting sober is hard, life-altering work, and the payoffs come at a glacial pace. All that in pill form? Forget it.

And yet my own knee-jerk skepticism feels a bit dangerous, a product, perhaps, of the stigma that still surrounds addiction. Despite our growing acceptance of the idea that alcoholism is a disease, drunks and addicts still make us very uncomfortable. We judge them harshly; we find it far harder to address the murky and multiple roots of addiction (social, psychological and physical) than its tangible results.

And so we read news reports about Darryl Strawberry, nabbed in Tampa with cocaine in his wallet, and we think, How stupid, how pathetic, what a complete failure of will. There may be elements of truth to that, but such swift judgment also betrays the limits of our compassion.

People who overcome their problems once and for all are redeemed; those who relapse are reviled. Missing from view is the vast middle ground of addicts, of people who live out complicated, shame-ridden cycles of sobriety and relapse that can go on for years.

The bias isn't limited to addicts. We harbor similar suspicions about the mentally ill, secretly (and sometimes not so secretly) linking Prozac use with weakness, superficiality, lack of moral fiber. We have next to no sympathy for the obese; greater understanding of the genetics of obesity -- and a newly approved pill to combat extreme cases -- will probably do little to dampen the deeper sentiment that corpulence is really a product of gluttony and laziness. When it comes right down to it, biology be damned; whether it's food, drink or despair, solving these problems ought to be a test of our values and determination. It ought to be hard.

Indeed, the automatic criticism of meds -- that they're a quick fix, avoidant and simplistic -- reflects a general suspicion not only that problems like addiction can't be fixed with drugs but also that they shouldn't be. It indicates that for all our nods to the disease model of alcoholism, we continue to believe that it's actually a moral problem, the result of deep and frightening character flaws. Treat addiction medically? Like a "real" disease? Better to keep drunks hidden in church basements, where they belong.

Church basements, of course, may be precisely the place to find enlightenment, for both individuals and the larger culture. At an A.A. meeting not long ago, I heard a young woman, just out of rehab, talk about how it felt to be home alone, dying for a drink. She described quite eloquently the tapestry of feeling behind that craving -- threads of loneliness and boredom, of sorrow and inexplicable need, the whole range of sensation that addiction so effectively, if temporarily, keeps at bay.

As I listened, I thought about this body of drug research, about how science might serve her. It's doubtful that meds alone could ease the tangle of longing that led her, like so many, to self-medicate in the first place. Not even neuroscience can come up with a shortcut across the minefield of sober human emotion. But it's possible that medication could ease the specific craving, mitigate the discomfort long enough to get her to the next meeting, and then the next.

That's promising: if a drug can give you an edge, provide enough relief and agency to help you start fighting back, there's no reason to be against it. Very gradually, neurology has helped coax depression out of the closet, destigmatizing it enough to help countless Americans seek help.

Perhaps antiaddiction pills will have a similar effect, easing not just cravings but shame.