18.4 Years to the Bottom

After 19 years of practicing at a hospital for alcoholics in Seattle, Dr. Paul O'Hollaren is acutely aware of each move leading to the bottom of the bottle. For the guidance of general practitioners, Dr. O'Hollaren in Medical Times charts a timetable of symptoms drawn from 147 male patients who began drinking at ages 18 to 19, and eventually wound up in his Shadel Hospital. Dr. O'Hollaren's statistics confirm his theory that it usually takes about 18 years to become a confirmed alcoholic. The journey's main stages:

First Symptoms. These show up as early as two years after social drinking begins, form a syndrome that lasts about 12.5 years. The potential alcoholic first takes to sneaking drinks and downing doubles or triples while others are still at the one-drink stage. Soon he gets drunk whenever he drinks, even against his wishes. Next he thinks often about drinking, its balm to life's stresses, begins drinking through the weekend and taking Monday off from his job to recuperate. Though a doctor who knows him well may spot such telltale symptoms early, "all too often the patient is unwilling to see or unwilling to admit that as yet his drinking is a problem."

Time for Treatment. "Overt alcoholism," the last good chance for recovery, spans roughly 5.9 years. The patient becomes a liquor hoarder, buys large quantities, worries whether he has enough to last through some particular crisis. This behavior is followed closely by drinking before breakfast (more than 95% of all alcoholics treated at Shadel Hospital have admitted doing so). The patient insists that he never gets "drunk," which may be true, since a constantly high level of blood alcohol need not impair his actions at first. Later it does; more and more he cannot seem to "hold" his liquor, may finally admit to himself that he is really "drunk." It is hard to deny; he can no longer control his behavior, is beset by marriage, money and job crises. His main problem is accepting a doctor's diagnosis: alcoholism.

Little Hope. Ultimate symptoms multiply--delirium tremens, extreme nervousness, avitaminosis. The patient deteriorates physically, socially, maritally, emotionally, occupationally, neurologically. Treatment becomes more difficult; the prognosis rapidly dims. The alcoholic has hit bottom. Mean time for Dr. O'Hollaren's 147 patients: 18.4 years.

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