Rise of the Sober Drunk
IN THE WINTER OF 1945, director Billy Wilder took a seat in the back of a theater in Santa Barbara, California, and waited to hear how the audience would react during the first preview of his new film, The Lost Weekend. The movie was based on a best-selling novel by Charles Jackson that told the story of five days in the life of an alcoholic, Don Birnam. Wilder had bought the book at the Chicago train station and had read it twice by the time he arrived home in Los Angeles. “Not only did I know it was going to make a good picture, I also knew that the guy who was going to play the drunk was going to get the Academy Award,” he said later.1 Wilder, who was just beginning his career as one of Hollywood’s leading writers and directors, knew a good story when he saw one. But the movie had been nothing but trouble since its completion. The censorship boards that existed in many states were insisting on cuts to protect the public from what they saw as shocking scenes of alcoholic depravity. Their British counterparts forced Paramount Pictures to delete the film’s climax—Birnam’s attack of delirium tremens. The liquor industry was so fearful that the movie would fuel a resurgence of prohibitionist sentiment that it offered to buy it for $5 million.2
Wilder and producer Charles Brackett, who had cowritten the screenplay, were nevertheless unprepared for what they heard that night in Santa Barbara. In an early scene, Birnam’s brother, Wick, discovers that Don has hidden a bottle of whiskey by tying a string around the neck and hanging it outside a window. “How did it get there?” Wick demands. “I suppose it dropped from some cloud. Or someone was bouncing it against this wall and it got stuck?” The audience members burst into laughter. Most departed before the end, leaving comment cards that called the movie “disgusting” and “boring.” Sitting in their car later, Wilder told Brackett the film was now his problem—he was moving on. “If they would have given me the five million, I would have burned the negative,” Wilder recalled.3
That would have been a mistake. The audience was reacting not to the substance of the story but the clash between a temporary score that suggested a lighthearted comedy and the tragedy of the story line. People didn’t know whether to laugh or cry. When new music was added that featured the spooky oscillations of the theremin, one of the first electronic musical instruments, the mood of the film changed dramatically. At a preview in San Francisco that ended well after midnight, no one left early and the audience was “positively limp” by the end. The movie opened to rave reviews, and the box office boomed in response to an ad campaign that promised, “The amazing novel you whispered about rocks the screen with its daring!” Several months later at the Academy Awards, actor Ray Milland received the Oscar for best actor. What Wilder had not foreseen was that Lost Weekend would also sweep the awards for best picture, best director, and best screenplay.4
Lost Weekend appeared at a moment when attitudes toward alcohol and alcoholics were in flux. Americans had abandoned their “noble experiment” of banning the sale of alcohol, but they lacked a clear vision for how to deal with the problems that led to Prohibition. The ancient stigma against alcoholics remained strong in the minds of average Americans as well as those of the scientists and medical professionals whose help drunks desperately needed. There were also glimmers of change. A review of popular literature during the opening decades of the twentieth century shows that there was a steady decline in the number of articles reflecting the view that alcoholism was the result of moral weakness. With the rapid growth of medicine and greater popular acceptance of the importance of science for explaining all aspects of modern life, there was an opportunity to reconsider the plight of the alcoholic.
Lost Weekend contributed to this change. Charles Jackson’s novel portrayed the life of an alcoholic with scalding realism. To ensure its accuracy, he had interviewed doctors at Bellevue Hospital. He wouldn’t have gone to Bellevue at all if he had been able to remember his two previous visits as a patient in the alcoholism ward. He had been sober for six years when he began writing his novel, and it documented in great detail the depths of alcoholism. In its first five years, the book sold almost a half-million copies and was translated into fourteen languages. The movie reached an even wider audience.
The movie did more than titillate. A poll conducted among New York University students who had seen it revealed that 78 percent believed alcoholism was an illness that required specialized treatment. Two decades later, Selden Bacon, the director of the Rutgers University Center of Alcohol Studies, would look back at the publication of Lost Weekend as a turning point. “Since Charles Jackson wrote the book in 1944, a great change has occurred in the attitude of most Americans toward alcoholism—a change that made possible the first really constructive steps toward control of the problem,” he wrote. Like Jackson, many of the men and women who were responsible for that change were sober drunks.5
Lost Weekend was still flying off the shelves of bookstores on October 3, 1944, when a new organization, the National Committee for Education on Alcoholism (NCEA), announced that it was opening an office in New York City. It was the first step in what would become a far-reaching campaign to sell the public on three key ideas:
1. Alcoholism is a disease and the alcoholic is a sick person.
2. The alcoholic can be helped and is worth helping.
3. This is a public health problem and a public responsibility.
In its initial press release, NCEA acknowledged that it had a mountain to climb. “The alcoholic is a perennial problem-child,” it said. “No one knows what ails him or why he acts as he does. He is generally regarded at best as a willful nuisance, at worst as a vicious criminal.” But this idea was mistaken. “Actually, he is suffering from a terrible illness: the disease of alcoholism.” There were at least three million alcoholics in the United States, the NCEA said. An assistant surgeon general had described it as “America’s Public Health Problem No. 4,” and the problem was going to grow. The Allies were now marching toward Berlin, and there was every reason to believe that the disruptions of the postwar period would lead to more drinking. There was a solution. “The phenomenal success of Alcoholics Anonymous, with over 12,000 rehabilitated alcoholics in its membership, proves this point,” the NCEA said.6
These were bold words for a fledgling organization. Calling alcoholism a disease and pointing to the success of AA, which had been virtually unknown to the public just a few years earlier, was not going to change things. “[P]eople persist in regarding alcoholism as a moral issue rather than as a health problem,” the NCEA admitted. But it had a plan. “Our specific program includes: lectures on alcoholism, the distribution of literature, the formation of local committees all over the country, and the establishment by them, with the aid of the National Committee, of information centers or clinics in their communities.” It also had institutional support from the Center of Alcohol Studies that had recently been established at Yale University (later at Rutgers) to encourage scientific research into alcohol and the problems that it caused. NCEA boasted an impressive advisory board that included some experienced alcohol researchers, public health officials, religious leaders, and a couple of celebrities—author Dorothy Parker and actress Mary Pickford. “The founder and co-founder of Alcoholics Anonymous” were also listed, although they were not identified. The names of Bill Wilson and Dr. Robert Smith appeared further down the list without affiliations.7
The biggest thing the NCEA had going for it was its executive director, Marty Mann. It was somewhat surprising that the new organization was headed by a woman. While women had been leaders in the fight for Prohibition and female suffrage, the prevailing view in American society was still that women should be wives and mothers. It was probably shocking to many reading the NCEA press release to learn that Mann was “a recovered alcoholic and an early member of Alcoholics Anonymous.” The prejudice against alcoholics was strong, but society judged women alcoholics more harshly than men. Many assumed they were prostitutes.8
One of Mann’s greatest qualifications for her job was simply that she was the first-born daughter of a wealthy Chicago family that could trace its roots back to the Puritans. She had attended elite girls’ schools, completing her education with a year at Miss Nixon’s School in Florence. When she returned, she was introduced to high society at a debutante ball. Her upper-class breeding was apparent during thousands of public appearances over the next twenty-five years:
Onto the stage strode a tall (five-foot, eight-inch), handsome, elegant, self-assured woman, her carriage erect and graceful. As one reporter said, “Any woman would have known that her gown of soft gray wool combined with knit came straight from an exclusive designer.” Wearing a dramatic hat in the fashion of the day, her short blondish hair in a stylish cut, blue-green eyes snapping, Marty stepped to the microphone.
The woman was a lady.9
Mann had also been a terrible drunk. She had always been a handful. “Anyone who knew me could testify that I had been afflicted with a little too much of that commodity known as willpower,” she said. In her late teens, Mann turned her enormous energies to drinking. Like all alcoholics, she initially enjoyed a high tolerance for alcohol that allowed her to drink her friends under the table and then drive them safely home at the end of the evening. She married and divorced, moved to New York where she started a career in magazine journalism, and two years later, left for London where she opened and ran a successful photography studio.10
By 1932, however, Mann was an alcoholic who was drinking up to two quarts of scotch a day when she could afford it. She attempted suicide once and may have been trying again when she fell out of a second-story window onto a stone terrace, suffering injuries to her face and hip that would bother her for the rest of her life. On her return to the United States, she was carried from the Queen Mary on a stretcher because she was too drunk to walk. She spent two years in hospitals and sanitariums seeking a cure for her problem before a psychiatrist gave her a manuscript copy of Alcoholics Anonymous. On April 11, 1939, at the age of thirty-four, she attended her first AA meeting at the Wilsons’ Brooklyn home. Although she wasn’t the first woman member of AA and suffered several brief relapses, Mann was the first AA woman to stay sober.
Mann learned a lot about alcoholism over the next two years. Like most AA members, she did not have a job when she got sober. So following her release from the sanitarium, she had a lot of time on her hands. AA newcomers were given a sponsor who guided them through the twelve steps. Later, AA would recommend that sponsors be the same sex as the persons they sponsored. With no woman available to sponsor Mann, Bill Wilson took on the job. Mann spent a lot of time with Wilson and accompanied him on a trip to Akron where she met Bob Smith. She also worked with more than a hundred women alcoholics during her first year of sobriety but failed to help any of them get sober. Mann was not discouraged, but she had fewer hours to give to AA after she finally found a job as a publicist at Macy’s in the fall of 1940.
A chance meeting during lunch with her coworkers started Mann thinking about leading a campaign to educate the public about alcoholism. She noticed Grace Allen Bangs of the New York Herald Tribune sitting at a table nearby. Bangs had tried to help Mann get a job during her drinking days, but she did not recognize the young woman who walked over to say hello. “What in heaven’s name has happened to you?” Bangs asked. “You have lost at least twenty pounds and you look ten years younger.”11
Bangs listened closely as Mann told her story. Her son was an alcoholic, and she had searched in vain for information about what was wrong with him. “It’s fabulous how little I know,” Bangs said. “There must be thousands of mothers and wives like me. Marty, you must tell them.” Bangs was a woman of considerable influence. As the head of the Herald Tribune‘s Club Service Bureau, she knew the leaders of all the women’s clubs in the city, including women of great wealth and position. “We should have a primer on alcoholism, pamphlets, an information center. We should organize a committee that will find a way to finance it,” Bangs said. Mann did not encourage her at first. She was just getting back on her feet and would soon leave Macy’s for another job.12
As time passed, Mann began to give serious consideration to the idea. She was aware of a number of favorable developments. In 1940, she and Wilson attended a meeting of a new group, the Research Council on Problems of Alcohol (RCPA). Founded five years after the repeal of Prohibition, the original goal of the RCPA was to undertake scientific research on a broad range of problems created by alcohol. By 1940, however, it had narrowed its focus to “the disease of alcoholism and the alcoholic psychoses.” At the same time, it indicated that it would advocate solutions as well as conduct research. “The Research Council on Problems of Alcohol hopes to take a place with the public health agencies now combating tuberculosis, syphilis, poliomyelitis, cancer, and other major diseases,” the RCPA director Harold H. Moore declared. These words had special meaning for Mann. She had contracted tuberculosis when she was fourteen and knew that prejudice against TB patients was once widespread. Mann was familiar with the important role that the National Tuberculosis Association had played in eliminating the stigma.13
Funding problems prevented the RCPA from fulfilling its ambitious mission, but it attracted others with the same goal. One was Dwight Anderson, an expert in the new field of public relations who became a consultant to the RCPA and the head of its committee on publicity. Anderson was an alcoholic who had stopped drinking in 1932. When he was admitted to the psychiatric clinic of New York Hospital, he was fifty and addicted to the barbiturates that he took to keep from drinking. The attending physician described him as “a disheveled man of past 60, with a bad heart and an incurable mental disorder.” Only one young psychiatrist, Dr. William B. Cline, believed there was any hope for him. Over the next two months, he helped Anderson identify his psychological problems. Unlike many psychiatrists, however, Cline did not believe that Anderson could begin drinking again. “Sooner or later, you will find yourself on the point of taking a drink,” he warned. “Stop for a moment and answer this question, ‘Just what do I expect to accomplish by taking this drink?’” The question had helped him stay sober for eighteen years.14
In 1942, Anderson wrote an article, “Alcohol and Public Opinion,” that looked at the problem of alcoholism from his perspective as a public relations man and alcoholic. From the PR perspective, things couldn’t be worse. There was no social group that viewed the drunk with any sympathy. Everyone assumed that alcoholism was incurable, including doctors. But as a sober drunk, Anderson knew that this fatal diagnosis ignored the facts. Since the days of Benjamin Rush, there had been doctors who recognized that alcoholism was treatable. Anderson cited recent statistics showing that as many as half of drunks could quit drinking or at least reduce the amount they drank. Society had reached an impasse. “The expert awaits a changed public; the public awaits a change in the expert. The result is a stalemate,” he wrote.15
Anderson believed the stalemate could be broken once the public realized that the alcoholic drank because he was sick. Several key propositions followed:
Sickness implies the possibility of treatment. It also implies that, to some extent at least, the individual is not responsible for his condition. It further implies that it is worth while to try to help the sick one. Lastly, it follow from all this that the problem is a responsibility of the medical profession, of the constituted health authorities, and of the public in general.
The tools for delivering this message were at hand. “When the dissemination of these ideas is begun through the existing media of public information, press, radio and platform, which will consider them as news, a new public attitude can be shaped,” Anderson wrote. It had been done before in the fight against other “incurable” illnesses, including TB, cancer, syphilis, and mental illness. He continued, “Once the opposite concepts were established, it became a thrilling adventure to help to save the health, lives or minds of people by participation in these enterprises.”16
Mann was stirred by Anderson’s words, but she hesitated to answer his call to action. She had found a job writing radio scripts for the American Society of Composers, Authors and Publishers and was quickly promoted to director of research. After years of joblessness, she was reluctant to give up security, and it seemed clear that it would be necessary to start a new organization. The prospects of such a group seemed shaky at best considering the RCPA’s financial struggles. On the other hand, there was an opportunity to do for alcoholics what Dorothea Dix had done for the mentally ill.
One night in February 1944, Mann found herself unable to sleep. At 3 a.m., she went to her typewriter and wrote the first description of the NCEA. She discussed the plan with Wilson, who was supportive, but told her that obtaining the sponsorship of a scientific organization was crucial. She also consulted a small group of supporters that included Anderson, Bangs, and Dr. Ruth Fox, who had turned to Mann for advice about her alcoholic husband. The committee suggested that she approach the RCPA. The group was willing to hire her as a speaker, but Mann had set her sights higher.
Fox then urged Mann to contact E. M. Jellinek, the director of the new Center of Alcohol Studies at Yale. Jellinek had become interested in alcoholism while working as the director of research for the United Fruit Company in Honduras. Trained as a biometrician, Jellinek’s job was to analyze medical statistics, discerning trends and recommending priorities for treatment. When he discovered that alcoholism was rampant among the employees of United Fruit, he began to collect all the information he could about the problem. This led to a job with the RCPA and then to Yale, where he cofounded the Center of Alcohol Studies. The main work of the center in the early years involved research on alcoholism, including physiological, social, psychological, and historical studies. The center had begun publishing a Quarterly Journal of Studies on Alcohol, providing a platform for disseminating scientific studies of alcoholism for the first time since the demise of the Quarterly Journal of Inebriety. It also launched a monthlong summer school to educate anyone whose work involved alcoholics. In its first seven years, a faculty composed of physicians, physiologists, attorneys, clergy, and AA members delivered lectures to over a thousand students.
The Center of Alcohol Studies provided services directly to alcoholics at clinics in Hartford and New Haven. Patients received individual counseling and were encouraged to attend AA meetings. Ray McCarthy, the executive director of the Yale Plan Clinic, had pioneered a new form of therapy in which patients met in small groups to listen to short talks on some aspect of alcoholism and then discuss the issues among themselves. McCarthy, who was a sober alcoholic, had been trained by Richard Peabody, a drunk who worked as a therapist following his recovery at the Emmanuel Church clinic. McCarthy believed that group therapy helped overcome the alcoholic’s isolation and made it possible for him to recognize the nature of his problem. He also believed that sober alcoholics with proper training could play an important role as therapists. The Yale Plan Clinics treated more than five hundred patients in their first two years of operation, a period when government was spending almost nothing on alcoholism.
Jellinek responded enthusiastically when Mann described her plan for an education campaign. He traveled to New York City the next day to meet with Mann, her planning committee, and Wilson. He offered to pay all the expenses of the NCEA for the first two years and to continue to provide support after that. To educate herself about alcoholism, Mann began commuting to New Haven to work with the staff of the Center of Alcohol Studies, living with “Bunky” Jellinek and his wife during the week. In the summer, she joined eighty-eight other students at the second Yale Summer School of Alcohol Studies. Almost half of her classmates were ministers, and not all were sympathetic to alcoholics. Mann overheard a comment by one clergyman during a class trip to an AA meeting in New Haven. “If I had my way, I’d put them all on a boat and sink it,” he said. She spent several evenings trying to convince another student, Mrs. D. Leigh Calvin, that alcoholism was a disease. Finally, Mrs. Calvin, president of the WCTU, agreed. Jellinek had hired the right woman.17
The press release announcing the creation of the NCEA made a big splash in October 1944. All nine New York City newspapers carried the story, and the three national wire services spread the news throughout the country. Within days, editorials began to appear welcoming “A New Rational Solution” to the problem of alcoholism. The favorable publicity that AA received since the publication of Jack Alexander’s 1941 profile in the Saturday Evening Post undoubtedly helped draw attention to the new group, which appeared to be a logical next step toward a broader understanding of the problem. The fact that a novel about alcoholism was currently on the best-seller list didn’t hurt either. A decision by Mann gave the press release extra impact. Although she had adopted Dwight Anderson’s key concepts for a public education campaign, making them the centerpiece of the press release, she believed that his characterization of the alcoholic as a “sick” person was not strong enough. Mann described alcoholism as a “disease” five times in her brief release. She also suggested that there was a consensus among experts supporting this view. “The fact that alcoholism is a disease rather than a moral shortcoming has been known to scientists for years,” the release said.18
Mann was stretching the truth. Benjamin Rush and other doctors had described alcoholism as a disease in the eighteenth century. It was so regarded by the members of the American Association for the Cure of Inebriety beginning in 1870. But the scientists at the Yale Center of Alcohol Studies were unaware of the AACI and were only beginning their own research into the nature of alcoholism. Even Anderson had called it an illness, not a disease.
Mann believed that describing alcoholism as a disease was essential to countering the stigma against it. She explained later:
I want to make alcoholism respectable! So that all those uncounted thousands who are hiding or being hidden by their families like the proverbial skeletons in the closet, may realize that they are simply very sick people and come out for help. . . . The shame of it all is too much for them—they’d literally rather die of this ghastly disease than admit to having it.
One of the goals of the NCEA was to establish clinics where medical professionals could diagnose alcoholism and send patients to treatment. Based on her own experience, Mann believed that AA would be far more effective in getting people sober than doctors or psychiatrists. But she thought drunks would find it easier to take their first step toward sobriety by visiting a doctor. The existence of alcoholism clinics would also be a powerful symbol. “I believe that the very presence of a clinic will emphasize and advertise to the uninitiated that alcoholism is a disease,” Mann wrote.19
To get things started, the NCEA planned to form local affiliates led by prominent citizens. The launch of these groups in cities across the country was expected to generate a lot of publicity about the problem of alcoholism. The affiliates would begin by opening information offices to provide the latest facts about alcoholism to anyone who was interested, from newspaper reporters to students writing term papers. The information offices would also be a resource for alcoholics and their families, educating them about the nature of their affliction and suggesting where they might find more help.
Mann planned to spend most of her time traveling around the country making speeches and organizing local affiliates. In the beginning, she and Grace Bangs believed that socially prominent women would play an important role in her work. A women’s organizing committee was formed at the same time as the NCEA to ensure that it connected with the right people in each community.
The club women turned out to be a disappointment, but they were hardly missed. The extensive newspaper coverage of NCEA produced an avalanche of mail. In addition to hundreds of letters seeking help for individuals and requests for information, there were dozens of invitations to speak. During NCEA’s first year, Mann traveled 36,000 miles and delivered 106 speeches in 45 cities to 34,000 people. Fourteen of her addresses were broadcast on radio.
When there was enough support, Mann’s speeches were used as the occasion to launch a local committee. An organizing committee was formed to plan for Mann’s visit, scheduling a press conference soon after her arrival and arranging at least one talk a day. After her speech, Mann met with the organizers and other interested people; a temporary chair was selected and chose an executive committee that then voted to affiliate with NCEA. Five affiliates were organized in the first nine months. Mann began delivering more than two hundred speeches annually, and the number of local committees grew to thirty-nine in 1948, including state affiliates in Utah and Rhode Island. A public opinion survey suggested there had been a significant increase in the number of people who believed alcoholism was a disease. “[O]ur campaign of education of the public has helped change the opinion of more than 30 per cent of the adult population,” Mann said.20
The NCEA had certainly had a significant impact, but so had the rapid growth of AA. Between 1945 and 1950, AA membership increased from twenty thousand to over a hundred thousand in twenty-five hundred groups. Mann was counting on their help. She was one of the founding editors of the monthly AA Grapevine, which began publishing shortly before the launch of NCEA. So it was no coincidence when the same issue that announced the new group also included an interview with Mann. “Why, Marty, what about us A.A.s helping?” the interviewer asked. Mann agreed. “There’s no reason why they shouldn’t be. It’s my hope that they will, either as groups or as individuals. After all, we A.A.s are the people who understand best how misunderstood this whole thing is,” she said. Many of the speeches that Mann made every year were delivered to AA groups, and she encouraged AA members to hold open meetings where committees could be formed.21
AA members answered Mann’s call. Sober drunks played an important role on many of the executive committees that organized local committees, and when committees succeeded in opening an information office, they often hired a recovered alcoholic to run it. There were so many AA volunteers that Mann began to worry they would swamp the boat. NCEA was seeking broad support for its goals, and it promoted the fact that local committees were chaired by judges, college presidents, doctors, religious leaders, and businessmen. One AA volunteer was encouraged to take on the job of organizing an affiliate but also warned about being too prominent in the new organization. “We should have the fullest cooperation and support from A.A. members, but in order to get this with the least trouble and misunderstanding we suggested that A.A. members should be ‘on tap and not on top,’” Ralph McComb Henderson, Mann’s assistant, explained. There was also a danger that AA and NCEA would become so closely identified in the public mind that it would lead to confusion. Following a controversy over an NCEA fund-raising appeal in 1946, Wilson and Smith removed their names from the NCEA letterhead, and Mann stopped identifying herself publicly as an AA member.22
Although their independence had been clearly established, AA and NCEA still shared the goal of helping drunks, and their efforts often overlapped. They both gave the highest priority to breaking down the barriers that prevented alcoholics from receiving medical treatment in the nation’s general hospitals. From the beginning, AA’s leaders had believed that hospitalization was a necessary first step toward sobriety. Hospitalization was necessary because so many of the early AA members were men who had been drinking for years and were on the verge of physical collapse. They experienced delirium tremens and seizures when they were unable to get alcohol and sometimes died as a result. A hospital could also provide an opportunity for an alcoholic to think. Sober and sore, he had a chance to reflect on his life and to promise himself that he would never drink again.
The problem was that most doctors believed that alcoholism was incurable. Mann consulted eight doctors before she met Harry Tiebout, who had given her the manuscript of Alcoholics Anonymous. Anderson, who also consulted many doctors before he found the right one, believed that doctors were hostile to drunks because they had tried to help them and failed. They could help a man recover from a binge, but no matter how much he had suffered, he was soon drunk again. “Physicians like to feel that they have the full cooperation of the patient and are likely to resent the patient who professes one thing and does another,” Dr. Dexter M. Bullard explained.23
General practitioners did not have the time or the training to care properly for alcoholics. But what about the specialists in the field of psychology, which had grown astronomically in the decades since the days of alienist Joseph Parrish to include thirty-five hundred psychiatrists practicing in the United States? Many were willing to use the word “illness” when writing about alcoholism, but their understanding of alcohol addiction was also superficial. Some hoped to cure the patient through counseling aimed at underlying problems that they believed had driven the man to drink. More were convinced that the alcoholic was beyond help.
Six of the doctors that Mann consulted were psychiatrists who could not find anything wrong with her and refused to accept her as a patient because they did not know what to do with “people like you.” “[When] I frankly admitted under questioning that my drinking was out of control—from then on they wanted no part of me,” Mann said. The psychiatrists did not have much hope for any methods of recovery. A psychiatric intern had only discouraging words for a woman who had relapsed. “Well, I see you’re back here again, despite ‘Alcoholics Anonymous,’” he said.24
With many doctors either indifferent or actually hostile toward drunks, it was inevitable that hospitals would close their doors to them. According to the NCEA, only ninety-six general hospitals in the United States were willing to treat alcoholics in 1944, and only one accepted them without an argument. “I have long since lost count of the number of times that I myself have been told, on trying to gain admission for a desperately sick alcoholic, ‘This place is for sick people, not drunks,’” Mann wrote. Two of the men she was trying to save died for lack of medical care.25
An average of twelve thousand people were dying of alcoholism every year, including many who could have been saved if they had made it to an emergency room. Actually, the number was probably much higher because many families begged their physician to spare them the shame of an alcoholic family member by citing some other cause on the death certificate. Deaths “occurred in flop houses, boarding houses, and homes where the physician was either not called or would not respond to the call to treat a drunk,” Mann said. Many drunks died in jail. “We, as a nation, are not wont to treat our sick in that fashion. . . . And yet to a great body of very sick human beings we offer only punishment for their illness. We behave as if we are still in the Middle Ages.”26
As a result, AA and NCEA spent a lot of time trying to get drunks into the hospital. During the early years, Bob Smith succeeded in having drunks admitted to the Akron City Hospital using a diagnosis of “gastric distress.” Deaconess Hospital in Cleveland opened its doors to alcoholics only after AA appealed to the trustees, who overruled the medical staff. Clarence Snyder later described the difficulty he had in securing beds at the Post-Shaker Sanitarium, a hundred-bed facility in East Cleveland. The owner, Sara Post, was desperate for patients to replace those who had recently been moved to a new state facility. Snyder promised to pay twice as much as the state, but she was reluctant. Post didn’t like alcoholics and worried that they would be difficult patients. Snyder assured her they would be no more trouble than mental patients. “Most of ‘em won’t eat for the first few days; and if you taper ‘em off of booze, they’ll stay calmer than the loonies,” he said.27
Post agreed to accept alcoholics until one day when Snyder brought in a man who was near death. The editor of the Cleveland Press had begged Snyder to help find the man, who was a reporter for the paper. He was found in an abandoned warehouse on skid row. It was winter, and the man was lying unconscious on a damp concrete floor, barely breathing. Snyder took him to the sanitarium, but when Post saw who it was she refused to admit him. The reporter had been married to her niece and had ruined her life, she said. Snyder said he pleaded with Post and offered more money, but she refused. Post relented only after Snyder threatened to remove all the alcoholic patients. The reporter eventually recovered and moved to Houston, where he wrote a series of stories for the Houston Press that were collected in AA’s first educational pamphlet. He cofounded the first Houston AA meeting with an alcoholic minister he had helped rescue from skid row.
The hospitalization campaign received an important boost in 1939. Unable to find a place for one of his patients, Smith sought help from Sister Ignatia, the admitting nurse at St. Thomas Hospital in Akron. A member of the Sisters of Charity, Ignatia was a native of Ireland who had been raised to believe that drunkenness was a sin. But with the assistance of an emergency room intern, she had been helping alcoholics get treatment for several years before Smith approached her. “She was severely criticized by some of the nuns, and most of the doctors were bastards to her,” a medical intern, Thomas P. Scuderi, recalled. Overcrowding was a serious problem in American hospitals during the war years, but Ignatia found a place for Smith’s patient in a flower room that also served as a temporary mortuary. Although furtive in the beginning, officials at St. Thomas eventually agreed to treat alcoholics, even though most of the drunks were Protestant. A newly remodeled eight-bed ward opened in 1944 to accommodate alcoholics who began traveling to Akron from around the country.28
Under the direction of Sister Ignatia and Smith, St. Thomas Hospital pioneered a treatment program in which AA played an important role. New patients were assigned an AA sponsor and required to demonstrate a sincere desire to stop drinking during an interview with Sister Ignatia or another admitting clerk. Each day of the five-day program had a theme. On day two, “Realization,” an AA member would guide the alcoholic through the first three steps of the AA program. The next day was devoted to “Moral Inventory.” Day four was the “Day of Resolution,” when the patient accepted the statement, “I can surely stay sober today”; the last day was devoted to planning for sobriety after discharge. Not many hospitals that agreed to accept alcoholics were willing to do more than detoxify them, but some worked closely with local AA groups, giving them the right to decide who would get treatment. In some large cities, drunks seeking treatment could call an AA “intergroup” for information.29
One of the fullest integrations of AA and a hospital recovery program occurred in the Knickerbocker Hospital, a fifty-nine-bed facility on 131st Street in Upper Manhattan. A 1914 directory of New York City hospitals described the Knickerbocker’s mission as assisting the “worthy” poor, but made it clear that alcoholics were not admitted. In 1945, the Knickerbocker dropped its ban, opening part of a nineteen-bed ward for drunks and later turning over the whole ward for that purpose. From the beginning, AA members in New York played a central role in the operation of the ward. Admissions were handled through the AA intergroup office in Manhattan, where the staff provided AA sponsors for all new patients. Even in the final months of World War II when hospitals were short-staffed, the Knickerbocker had no trouble finding sober drunks who were nurses to staff the alcoholic ward. As many as twenty AA volunteers worked as nurse’s aides every week.
AA set the rules at the Knickerbocker. “No families, no friends, no business colleagues may visit the wing—unless they happen to be A.A. members,” explained Mann, who continued to work closely with AA. “This gives the patient a temporary but complete release from outside worries and irritations, and plenty of time to think over his situation, and to make plans for dealing with his alcoholic problem upon release from the hospital.” It also gave him time to talk to his sponsor, fellow patients, and the AA volunteers, many of whom were former patients. Women alcoholics were treated in private rooms attached to the ward, although male and female patients were not permitted to mix. After five days of treatment, the patients were released and immediately joined AA groups. More than three thousand drunks were treated in Knickerbocker Hospital during the first three years of the program.30
NCEA also played a significant role in expanding hospitalization. It urged its affiliates “to survey the existing facilities (if any) for the care and treatment of alcoholics” and supplied a questionnaire to be sent to find local doctors who would be willing to treat them. The next step was to determine whether the affiliate had the financial resources to open a clinic like the ones in Hartford and New Haven. NCEA estimated that it would cost approximately $26,000 annually to employ a full-time psychiatrist, a psychiatric social worker, and three support staff. If the affiliate couldn’t afford a clinic, it was urged to open an information center staffed by one or two people who could refer alcoholics for treatment at local institutions. By the end of 1948, there were forty-one NCEA affiliates around the country. While none had been able to open a clinic, twenty-nine established information centers. On the national level, NCEA tried to educate doctors by offering a discount on subscriptions to the Quarterly Journal of Studies on Alcohol. In 1954, just ten years after the launch of NCEA, the number of general hospitals providing emergency care to alcoholics had grown from fewer than one hundred to over three thousand. AA groups had been organized in over two hundred of them.31
Hospitalization was a critical issue, but there were many pressing problems. What could be done to help alcoholics who were lucky enough to still have jobs? At the time, almost every company in the country considered drunkenness grounds for immediate dismissal. The issue was so important that AA addressed employers directly in the Big Book. A chapter titled “To Employers” urged businessmen to see their alcoholic employees as individuals. While some would have to be fired, “there are many men who want to stop, and with them you can go far. Your understanding treatment of their cases will pay dividends,” it said. The Big Book offered detailed instructions for confronting the employee, helping him find medical treatment, and dealing with him after he returned to work, even encouraging patience if a clearly earnest man suffered a relapse. The Big Book also recommended itself as a source of information about alcoholism that could be shared with junior executives, who might be in direct contact with the staff and in a position to help employees before they had been reported for drinking. Finally, the employer was urged to see the recovered alcoholic as a resource. “After your man has gone along without drinking for a few months, you may be able to make use of his services with other employees who are giving you the alcoholic run-around,” it said.32
The Big Book was right in predicting that sober alcoholics would play a role in helping their coworkers get sober. Several AA members began helping coworkers in the 1940s. David M. was inspecting bullets at the Remington Arms factory in Bridgeport, Connecticut, when he began taking men to AA meetings. Later he secured a job in the personnel department, which gave him an opportunity to talk to employees who were in trouble because of their drinking. His success in saving the jobs of twenty-two alcoholic workers led him to suggest to superiors that they adopt an official policy encouraging heavy drinkers to seek help. When they rejected the idea, he approached the medical director of DuPont, the company that owned Remington Arms. Dr. George H. Gehrmann had been looking for a solution for alcoholic employees for many years and had recently attended several AA meetings. “By God, you’re just the man I’m looking for,” Gehrmann said. In January 1944, David M. transferred to DuPont, becoming the first person hired by a company specifically to help alcoholics. During the same period, Warren T., an AA member who worked in a shipyard, was also counseling alcoholics full-time, although in an unofficial capacity. In March 1943, he informed the AA national office that in the first four days of his new job in the personnel department, he had met with seventeen men who wanted help with their drinking problem.33
The Yale Center of Alcohol Studies gave strong support to these first steps. In a speech to the Economic Club of Detroit in 1946, Jellinek provided statistics to demonstrate the enormous damage that alcoholism was inflicting on industry. He estimated that there were 3 million Americans who were either alcoholics or heavy drinkers in danger of becoming alcoholics. Approximately 510,000 were unemployable, including skid-row “bums.” Two million of the others were workingmen, including 1.3 million who were engaged in skilled and unskilled jobs in manufacturing, construction, and public utilities. Because each one missed an average of twenty-two days a year due to illness, the economy was losing nearly 30 million working days to alcoholism annually. Drinking caused more than four thousand accidental deaths every year. Alcoholics died twelve years sooner than nonalcoholics. Jellinek insisted the United States could do better. His most hopeful statistic was that an alcoholic could be rehabilitated for between sixty and a hundred dollars. A program that encompassed every alcoholic would entail less than a third of the social cost of alcoholism.
NCEA also focused on the problem of drunken workers. Its Chicago affiliate sponsored the First Industrial Conference on Alcoholism in 1948. Its greatest contribution to this phase of the alcoholism movement was Ralph McComb Henderson, a field secretary who traveled widely for NCEA before the Yale Center of Alcohol Studies hired him as an industrial consultant. “Lefty” Henderson was uniquely qualified for the job. He was a naturally gregarious man who had developed a successful law practice in his home state of South Dakota. One acquaintance described him as a “bear-like man, a friendly husky St. Bernard with a twinkle in his eye.” Another called him “an unmade bed.” A veteran of World War I, he became the state commander of the American Legion and served as the state chairman of the South Dakota delegation to the 1940 Republican National Convention. He had become an alcoholic by then, but he joined AA soon after.34
Henderson traveled constantly over the next ten years, speaking to company executives and business groups about the importance of helping their alcoholic employees. He was a charismatic speaker who used his “ham-like” hands to make sweeping gestures. Selden Bacon, Jellinek’s successor as head of the Yale School, called him “the most magnificent platform artist I ever saw.” In 1950, Henderson and Bacon developed a program called the Yale Plan for Business and Industry that sought to convince businessmen that alcoholism was a problem that could be managed in a cost-efficient way by identifying the few problem drinkers and getting them help. It described nine steps in creating an effective program, including educating top management, assigning responsibility to an existing department, and developing a policy to decide who would be offered treatment and who would be fired. Henderson won a key battle at Allis-Chalmers, an important manufacturer of agricultural and other industrial equipment. In 1950, he and an AA member, George S., helped persuade company officials in Milwaukee to hire an alcoholism counselor who had gotten sober in AA. The company was undeterred when the counselor suffered a relapse and mentioned its program prominently in company publicity.35
As companies began to start employee assistance programs, the evidence of their success grew. “For 28 years, I struggled without A.A., and my results were zero. With A.A. over the past five years, I got 65 per cent [sober],” Dr. Gehrmann declared. After the Allis-Chalmers program had been under way for eight months, the company reported that fifty-one of the seventy-one employees who had been identified as alcoholics had been helped. Not all had quit drinking and joined AA, but the others were either sober or had curtailed their drinking to the point where it was not interfering with their work.36
A sober drunk named William Swegan launched the first employee assistance program in the military in 1948. He was already an alcoholic when he joined the Army Air Force in 1939. He had lost his mother at any early age and was plagued by fear and a sense of worthlessness throughout his childhood. For a few years, drinking had allowed him to escape his problems. At twenty-one, he enlisted in an alcoholic haze, and he continued to drink heavily after he was stationed at Hickam Field in Hawaii. He was badly hung over when he awoke to the drone of airplanes on the morning of December 7, 1941. While the main force of Japanese planes focused on the nearby naval base, three waves of bombers hit Hickam, killing and wounding more than a quarter of the men in his squadron. Swegan himself was nearly killed by a bomb as he and five other men huddled in the corner of a hangar. His five closest friends—all drunks—died in the attack.
After serving in the South Pacific, Swegan returned home. He was sick with dengue fever and malaria, but he was refused admission to a Veterans Administration hospital because he was an alcoholic. His wife left him and wouldn’t let him visit his daughter. He was unable to hold a job. He tried AA, but he was half the age of the men at the meeting near his hometown in Ohio, and neither he nor they believed he was old enough to be an alcoholic. Out of options, he reenlisted for the security of a warm bed and regular meals and was assigned to Mitchell Air Force Base on Long Island, New York. Swegan began attending AA meetings again in nearby Valley Stream and was finally able to stop drinking in 1948.
Soon after joining AA, Swegan began thinking about how to carry its message to others. He didn’t have to look far to find alcoholic men and women. “There was an ample enough population of alcoholics in the armed forces. . . . And we were often a real problem to the majority of people around us,” he wrote later. He was already working with several airmen who were hard drinkers when he approached the squadron commander with the idea of giving a speech about alcoholism. The commander “looked at me like my sanity had left me,” Swegan said. Nevertheless, he agreed to the speech.37
The nervous airman got off to a rough start as he stood before 159 members of his squadron. “I am an alcoholic and have found a way to live a useful life without having to drink alcoholic beverages,” he began.
The whole room broke out in uproarious laughter on the spot. They knew all about how much I used to drink. . . . I really wanted to just crawl through the floor and disappear. But something different happened than had ever happened to me before in this kind of situation. I squared my shoulders and kept on talking.
The laughter stopped, and Swegan saw that the men were listening. Later, two quietly asked for help. “In the days that followed, two rapidly became four, and four became six, and six became eight. Something big was off and running, and I had no idea what was going to happen next,” he said.38
Swegan discovered that his recruits preferred attending AA meetings away from the base, where they did not have to worry about speaking before superior officers. He drove the men to the Valley Stream meeting in his car, until it broke down. The whole enterprise appeared to be at risk until a member of the AA group, Yvelin Gardner, gave him the money to buy another car. Gardner, the deputy director of NCEA, recognized the importance of Swegan’s work and used some of Mann’s many contacts to have Swegan assigned to the chaplain’s office. Swegan, who hadn’t graduated from high school, was also given a scholarship to attend the Yale Summer School of Alcohol Studies to help him prepare for his new career.
Swegan was so successful with the alcoholics at Mitchell Air Force Base that he worked himself out of a job. In 1953, he was given another chance at Lackland Air Force Base outside San Antonio, Texas. Lackland was a huge facility where all enlisted personnel underwent basic training. With strong support from the chief of psychiatry, Swegan had all the resources he needed to implement a large-scale rehabilitation program. Antipsychotic drugs were prescribed when necessary, and during early recovery, patients could request Antabuse (disulfiram), the nauseant that had become available only a few years earlier. Some patients received psychotherapy in individual or group sessions. Swegan said the most important component of the program was getting patients to regularly attend AA meetings conducted by civilians off the base.
Swegan believed that the Lackland rehabilitation program was a major breakthrough, and he produced evidence to prove it. He reported the results for the first fifty patients in the American Journal of Psychiatry. Half were sober and successfully performing their duties, based on evaluations provided by their superior officers. Another seven had improved. Swegan estimated that it had cost the air force over a million dollars to train these men, money that would have been wasted if they had been discharged for drinking.
Swegan took his story of success on the road, traveling to the many air force bases in Texas. He also established relationships at army and navy installations in the area, and many facilities opened rehabilitation programs. In 1954, Swegan was given an opportunity to make the case for providing alcoholism treatment at air force bases worldwide. Although still a sergeant, he traveled to Washington to appear before a committee of high-ranking officers investigating the problem of alcoholism in the air force. The committee members appeared interested, but he learned later that his proposals had been rejected as “too expensive.” Not long afterward, the chief of psychiatry, who had been Swegan’s partner, departed, leaving Swegan without the support he needed to maintain his program. Swegan retired from the air force and took a job running a small alcoholism treatment center. By then, the beginning of a movement to help alcoholics in the workforce was apparent. At least fifty companies had stopped firing employees because they were drunks. A few years later, the first permanent military alcoholism treatment facility was established at the Long Beach Naval Station by Dr. Joseph J. Zuska, a navy captain, and Dick Jewell, a recently retired navy commander who was an AA member.
By the early 1950s, sober alcoholics had made great progress. AA had grown to over a hundred thousand members, and many were actively engaged in helping others get sober. No one had done more than Marty Mann. On the tenth anniversary of the NCEA in 1954, she listed its accomplishments in a memo to her executive committee. The word “alcoholism” hadn’t even been used in the general press in 1944. Ten years later, “alcoholism [is] now fully and constantly covered in press. Every national magazine has run one or more articles on alcoholism,” she wrote. AA was the only group that supported NCEA in the beginning, but now “interest [is] shown by governmental, professional, and lay groups of all sorts.” Thirty-one states had established alcoholism programs. The NCEA staff had grown to include eight people working in two offices, distributing forty-two educational titles and answering two hundred pieces of correspondence per week.39
The members of the executive committee knew this was not the full story. Mann’s organization had been experiencing hard times after it separated from the Yale Center of Alcohol Studies in 1950. Renamed the National Committee on Alcoholism, it was having difficulty replacing the funding it had received from Yale. Also questionable was her claim to have achieved “general acceptance of disease concept . . . including AMA, medical societies, some industries, press, large segments of public, State government . . . U.S. Air Force, N.Y.C. Police Force, etc.”40
Mann was clearly exaggerating when she said the AMA was endorsing the view that alcoholism was a disease. The AMA had approved a definition of “alcoholism,” but that was as far as it was willing to go. There was no agreement on what caused alcoholism. Was it a psychological condition or the manifestation of a physical process that would qualify it as a disease? As late as 1955, Harry Tiebout, Mann’s psychiatrist and a strong supporter of AA, worried about the lack of evidence proving alcoholism was a disease:
I cannot help but feel that the whole field of alcoholism is way out on a limb which any minute will crack and drop us all in a frightful mess. . . . I sometimes tremble to think of how little we have to back up our claims. We are all skating on thin ice.
If the disease concept was discredited, the medical treatment of alcoholism might fall with it.41
But scientists were already engaged in research that would support the argument for treating alcoholism as a disease. Jellinek was perhaps the most influential. He had first entered the alcoholism field when he was hired to conduct a survey of all the existing scientific literature on the subject. After he joined the Yale Center of Alcohol Studies, he began his own research. In 1945, an AA group in New York’s Greenwich Village sent him the results of a questionnaire that it had created and distributed through the AA Grapevine to determine whether AA members shared characteristics of age, home environment, and drinking histories that might be statistically significant enough to draw some conclusions about the nature of alcoholism. Jellinek’s analysis of the data was published in 1946, suggesting the existence of phases in the drinking history of alcoholics. He immediately began revising the questionnaire, and a new survey was sent to every AA group with a request that it be distributed to the members. “[O]ne of the chief hopes and expectancies is that the data . . . will provide a new and still more complete set of warning signals by which potential alcoholics will determine how far along the road they have come,” the AA Grapevine said.42
Two thousand AA members completed the questionnaire, and the new data was published in 1952 by a committee of the World Health Organization (WHO). WHO had established an alcoholism subcommittee of its Expert Committee on Mental Health, and its first act was to recommend that WHO consider classifying alcohol as an addictive drug. Jellinek’s new article, “Phases of Alcohol Addiction,” provided support for such an investigation and presented the strongest evidence to date that alcoholism was a disease by describing in detail a process by which a normal drinker became an alcoholic.
According to Jellinek, in the pre-alcoholic phase, the incipient drunk was similar to other heavy drinkers, progressing from occasional to constant drinking for relief of anxiety and other personal problems. At the beginning of the second phase, he began to experience blackouts after drinking relatively little. He hid the fact that his drinking was increasing and drank before social engagements where he feared there wouldn’t be enough alcohol. He gulped his first few drinks of the day and began to feel guilty about his drinking. He stopped talking about alcohol and didn’t mention that his blackouts were increasing.
At the beginning of the “crucial phase,” the path of the alcoholic diverged decisively from that of other heavy drinkers. The heavy drinker might continue drinking for thirty or forty years and consume as much or more than the alcoholic, but he could stop and start at will. At the start of the crucial phase, which began from one year to seven years after the start of heavy drinking, the alcoholic lost the ability to stop drinking once he started and would drink until he was too drunk to continue. “The ‘loss of control’ is a disease condition per se,” Jellinek wrote.43
The drunk was not completely helpless. Once he was sober again, he could abstain for a time. Then someone offered him a drink, and he got drunk again despite his sincere desire not to. The alcoholic also began to suffer a series of personality changes: he started rationalizing his behavior, first to himself and then to his family, friends, and employer; his self-esteem suffered as he failed again and again to control his drinking, and he compensated with grandiose behavior intended to prove he was a good and important man. He became more aggressive and self-pitying. He was isolated and alone.
In the final, “chronic phase,” the alcoholic began to drink in the morning and didn’t stop for days at a time. He drank obsessively to obliterate the evidence of impaired thinking, ethical deterioration, indefinable fears, and uncontrollable tremors. He began to experience vague religious desires, but they didn’t last long. His system of rationalization finally collapsed. If he was still breathing, he was ready to admit defeat.
Jellinek’s article was accompanied by a chart that showed forty-three symptoms that were typical of the four phases of addiction. He emphasized that he was drawing a composite of the average drunk: not every alcoholic experienced every symptom, and the timing of symptoms could differ. Jellinek also acknowledged that he did not know what caused a person to become an alcoholic:
Whether this . . . process is of a psychopathological nature or whether some physical pathology is involved cannot be stated as yet. . . . Nor is it possible to go beyond conjecture concerning the question whether “loss of control” originates in a predisposing factor (psychological or physical), or whether it is a factor acquired in the course of prolonged excessive drinking.
The fact that so few excessive drinkers became alcoholics led him to guess that there was “a predisposing X factor in the addictive alcoholic.” Jellinek insisted that not knowing the cause of alcoholism didn’t mean that it wasn’t a disease. In his most significant work, The Disease Concept of Alcoholism, published in 1960, Jellinek concluded, “It comes to this, that a disease is what the medical profession recognizes as such [his italics].”44
Jellinek’s 1952 article and, later, his book gave scientific legitimacy to the campaign to recognize alcoholism as a disease. Another important step in the process was the growth of support within the medical community. One of the early leaders was Milton G. Potter, an alcoholic doctor in Buffalo, New York, who got sober in 1945 or 1946. In 1947, he founded an NCEA affiliate and persuaded the Erie County Medical Society to establish a special committee on alcoholism.
Potter also became reacquainted with a classmate from medical school, Marvin Block, another Buffalo doctor. Potter helped Block treat an alcoholic patient and persuaded him to join his alcoholism committee. The two men then persuaded the state medical society and twenty-one county societies to create alcoholism committees. The AMA was unmoved. It rejected a resolution urging the formation of an alcoholism committee twice in 1950. The AMA did create a subcommittee on alcoholism the following year, naming Potter as chair. But it never met because of a lack of funding.
Finally, in 1954, the AMA created a functioning subcommittee that included Block and Selden Bacon of the Center of Alcohol Studies. By then, Block was treating alcoholics exclusively, and he and Bacon developed a long list of objectives for the committee. They decided that the one most likely to win approval was a “Resolution on Hospitalization of Patients with Alcoholism.” “[A]lcoholism must be regarded within the purview of medical practice,” it declared, adding:
The Council on Mental Health, its Committee on Alcoholism, and the profession in general recognizes this syndrome of alcoholism as an illness which justifiably should have the attention of physicians.
The resolution was unanimously adopted by the AMA House of Delegates at a meeting in September 1956.
The AMA resolution did not use the word “disease,” but Mann and the burgeoning alcoholism movement eagerly claimed it as a vindication of the disease concept. It was also a turning point for the medical community as a whole. Block immediately began pushing for a similar statement by the American Hospital Association, which issued it a year later. After the Journal of the American Medical Association published the AMA resolution, it followed up with articles by Block, Bacon, and other members of the Committee on Alcoholism. In 1957, Block persuaded the AMA to distribute the articles in an official publication, Manual on Alcoholism.
Harold E. Hughes, a thirty-year-old Iowa truck driver, hit bottom in the same year that Jellinek published “The Phases of Alcohol Addiction.” Alcohol had been causing him trouble for many years. He was six feet two and powerfully built, weighing 220 pounds. He had been a member of an all-state high school football team. During the war, he carried a heavy machine gun into battles in North Africa and Italy. He was frequently involved in drunken brawls and was eventually court-martialed for striking an officer. His drinking worsened after his return to his hometown of Ida Grove, and his family started proceedings to have him committed to a state insane asylum. He escaped confinement by promising to stay sober but started drinking again after fourteen months. Feeling hopeless, he took a shotgun into the bathroom of his home and lay down in the tub with the muzzle of the gun in his mouth, touching the trigger with his thumb.
Hughes paused long enough to decide that he owed God an explanation for his suicide. Kneeling by the tub, he began to pray. He broke down in tears and was lying on the floor when he became aware of a new emotion. “A warm peace seemed to settle deep within me, filling the terrible emptiness, driving out the self-hate and condemnation,” Hughes wrote in his autobiography. Although he had been raised in the Methodist Church, Hughes had never felt a personal relationship with God. Now he had found “[a] God Who Cared, a God Who loved me. . . . Kneeling on the bathroom floor, I gave Him myself totally. ‘Whatever You ask me to do, Father,’ I cried through hot tears, ‘I will do it.’”45
Hughes had wanted no part of AA when he first heard about it. A friend who was a member had invited him to a meeting during the period he was in danger of being committed. Hughes thought he was doing fine on his own. He only considered AA again after he tried to rescue a drunken friend from Florida and ended up drinking himself. He went to his first meeting in a nearby town with another friend, began attending regularly, and established a group in Ida Grove. Once Hughes’s sobriety was firmly established, his career took off. He rose from driving a truck to managing a trucking company. He established an association that represented the interest of small truckers and won election to the Iowa Commerce Commission, which he eventually chaired. A columnist for the Des Moines Register called him “the most telling and moving orator I’ve ever heard.” A Democrat in a Republican state, Hughes was elected governor in 1962. Among his first guests at the state capitol were members of the small AA group in Ida Grove, who had joked about the day they would hold an AA meeting in the governor’s mansion.46
The state of Iowa had a commission on alcoholism by the time Hughes took office. Three-quarters of the states had created something similar, often locating a new division within the mental health department. This was a necessary first step, which involved educating state legislatures about the nature of alcoholism, and it provided support for the view that alcoholism was a medical problem that seriously affected public health. But the Salvation Army was still the largest provider of services to alcoholics in 1961. Most states lacked the money for treatment and rehabilitation.
Hughes encouraged the alcoholism commission to apply for a federal demonstration grant to fund an Iowa Comprehensive Alcoholism Program. The grant made it possible to open the first detoxification center in Des Moines and to improve coordination among government agencies, ensuring that alcoholics got access to the same services as other citizens. Iowa also created some of the first halfway houses, giving recovering alcoholics a place to live until they could get on their feet. Hughes insisted that the state government hire sober alcoholics and appointed one to the alcoholism commission.
Hughes was a liberal who was not afraid to take a strong stand on controversial issues. Soon after he became governor, he announced his opposition to capital punishment and succeeded in repealing it several years later. Iowans responded to his strong leadership. In the middle of his reelection campaign in 1964, a national magazine published an interview in which he revealed the fact that he was an alcoholic. His opponent attempted to use it against him, but the voters returned him to office with the largest majority ever given a candidate in Iowa, helping his party capture both houses of the legislature. Four years later, he was elected to the US Senate. By then, he had turned against American participation in the Vietnam War, and he would become a major critic of the policies of the new president, Richard Nixon.
There were many issues facing the new senator, but he had never forgotten the needs of alcoholics. Early in his term, he left Washington to assist a civic leader who had finally admitted his alcoholism. On the return flight, he wondered if he could do more:
It had been only 17 years since I had made the same admission. I thought of the hundreds of thousands of men, women and youngsters who never seem to find help, who live as derelicts or die tragically. . . . Was this one of the reasons I was brought to Washington, to represent the millions suffering from addiction to alcoholism and drugs?
Hughes was a deeply religious man. If God had given him a mission, he could not turn away.47
The federal government had only just begun to pay attention to the problem of alcoholism. In 1966, Lyndon Johnson, whose father was an alcoholic, became the first president to speak about the problem. “The alcoholic suffers from a disease which will yield eventually to scientific research and adequate treatment,” he said in an address to Congress. Soon after, the Office for Economic Opportunity, which created programs to fight Johnson’s “war on poverty,” began to award grants for the establishment of alcohol programs by state and local governments. These programs had made only the barest of beginnings by the time Hughes arrived in Washington. The administration had requested only $4 million for community alcoholism programs in 1969. “This is like trying to stop the Mississippi River in flood stage with a pebble,” Hughes said.48
Things began to change when Hughes became the chair of the Special Subcommittee on Alcoholism and Narcotics. The new chair scheduled his first hearing in July 1969. Four of the five witnesses on the first day were sober alcoholics, including the actress Mercedes McCambridge and Ray Harrison, an Iowa attorney who had been thrown into the very jail that he later supervised as a municipal judge.
Bill Wilson and Marty Mann testified on the second day. Before Wilson spoke, Hughes announced, “For the next witness, there will be no television. There will be no pictures taken.” Wilson was eighty-four and suffering from emphysema. But he had survived to see the federal government address the problem of alcoholism. “For me, this is an extremely moving and significant occasion. It may well mark the advent of the new era in this old business of alcoholism,” he said. The Apollo spacecraft had landed with the first men on the moon only a few days earlier. “This is splashdown day for Apollo. The impossible is happening,” Wilson said.49
The following spring, the Hughes subcommittee introduced legislation that was nearly as ambitious as the moon shot. Hughes had asked a Washington lawyer, Peter Hutt, to draft the bill. Hutt had led the American Civil Liberties Union’s campaign to get the courts to recognize that alcoholism was an illness and to send drunks to treatment instead of jail. He was an expert on alcoholism. When Hughes gave him just a weekend to write the legislation, he closeted himself with young associates of his law firm and met the deadline, presenting Hughes with a bill, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act.
Hutt and his associates had examined every federal program that could be used to help alcoholics and created an “administrative structure for a greatly expanded, comprehensive and for the first time well-coordinated federal attack on the problem of alcohol abuse and alcoholism.” “There was everything in it but the kitchen sink,” Hutt said later. The most important feature of the bill was the creation of a new federal agency, the National Institute on Alcohol Abuse and Alcoholism. The Hughes bill also authorized expenditures of $300 million for grants to state and local governments, nonprofit organizations, and individuals providing services to alcoholics over the next three years. Mann called the Hughes bill “an emancipation act for alcoholics.”50
Hughes and his staff now had the difficult task of moving the bill through Congress. The support of sober alcoholics would be a key to its success. Hundreds of them sought jobs in his office, and one woman, Nancy Olson, became a key player in the legislative campaign. Olson had been sober several years and was working part-time for a congressman when she became a volunteer in Hughes’s Washington office. She had been hired for a full-time position a few months before the Hughes bill was introduced.
Olson wanted to see the bill passed without changes and often pushed her boss to oppose compromise measures. Hughes did not always listen to her, but she acted as a voice for alcoholics at important moments in the fight. During a committee hearing, a senator asked if a provision of the bill that barred discrimination based on a person’s drinking history would prevent him from firing an employee who got drunk and punched him in the nose. Hughes turned to Olson. “How do you feel about that, Nancy,” he asked.
I was stunned and flustered. . . . I think I replied something like this, “Well, Senator Dominick, as a U.S. Senator you are exempt from provisions such as this. You can fire anyone you want to for no reason at all. But if the behavior is caused by a drinking problem, we would hope that you would first give your employee an opportunity for treatment and rehabilitation.”
Hughes turned back to the senator. “That is how we alcoholics feel about it,” he said.51
For the most part, the alcoholics had their way, but they did suffer setbacks. The National Institute on Alcohol Abuse and Alcoholism was created within the National Institute of Mental Health, raising concern that the problem of alcoholism might not receive the attention it deserved. A provision requiring the establishment of alcoholism treatment and rehabilitation in the armed services was removed because of a jurisdictional conflict with another Senate committee.
No other significant amendments were made before the bill was brought to the floor of the Senate for a final vote in August 1970. No senator was willing to oppose the bill openly, and it was approved by voice vote. On returning to their office, some members of Hughes’s staff pulled bottles of whiskey from their desk drawers to celebrate. Olson didn’t object. “Still, it seemed a strange way to celebrate the passage of an alcoholism bill,” she said.52
The fate of the Hughes bill was still uncertain. The House did not consider the legislation until late in the year, and it was possible that it would not come up for a vote before Congress adjourned. Even if it passed, there was a good chance it would be vetoed. President Richard Nixon was trying to dismantle Johnson’s welfare programs by turning over responsibility to the states. Two members of Nixon’s cabinet were arguing against adding an institute on alcoholism to the federal bureaucracy.
Sober drunks across the country were convinced that their moment had come. AA does not endorse legislation. But by the early 1970s, there were more than five hundred thousand AA members worldwide, and many in the United States rallied strongly behind the Hughes bill. Calls and letters poured into the House Rules Committee, forcing the bill onto the floor where it was approved by another voice vote. Sober alcoholics in the Republican Party urged Nixon to sign the bill, including Thomas P. Pike, a prominent party member from California who had served in the Eisenhower administration, and James S. Kemper Jr., the president of Kemper Insurance Company.
R. Brinkley Smithers may have played the decisive role. Smithers was the son of an IBM founder who had devoted much of his time and fortune to the alcoholism movement since getting sober at Towns Hospital in 1954. He persuaded Don Kendall, the head of PepsiCo, to call the president, who was a close friend. Although Nixon was not happy about it, he signed the bill.
Passing a bill didn’t matter much if there were no funds for implementing it. In 1971, Congress appropriated only $12 million of the $100 million authorized by the Hughes bill. Another $100 million had been earmarked for 1972, but the appropriations committee approved only $25 million. Olson reported that Hughes “blew his stack” and complained so loudly that he was finally invited to address the committee.
During the walk to the hearing room, Olson and her boss were grumbling over the appropriation when Hughes suddenly stopped. “Listen to us, Nancy, son of an alcoholic dirt farmer in Iowa and the daughter of an alcoholic laboring-class man in Pennsylvania, carrying on about a ‘lousy $25 million,’” Hughes said. The sound of their laughter echoed in the marble hall.53