Diagnosed Alcoholic

"At last, now, I was thoroughly conscious that I desired alcohol. But what of it? I wasn't afraid of John Barleycorn. I had associated with him too long. I was wise in the matter of drink. I was discreet. Never again would I drink to excess.

"I knew the dangers and the pitfalls of John Barleycorn, the various ways by which he had tried to kill me in the past. But all that was past, long past. Never again would I drink myself to stupefaction. Never again would I get drunk. All I wanted, and all I would take, was just enough to glow and warm me, to kick geniality alive in me and put laughter in my throat and stir the maggots of imagination slightly in my brain.

"Oh, I was thoroughly master of myself, and of John Barleycorn."

- Jack London, John Barleycorn, or, Alcoholic Memoirs, 1913

I blinked like Lazarus, bewildered at my surroundings. I was sitting on a cold apartment floor in Washington, D.C., smoking a cigarette in the dark. Cool blue light from the street angled through the blind and painted my thighs in indigo stripes. I had no idea where I was or how I had gotten there.

I rocked back and forth nervously, like an anxious child waking from a nightmare. Objects near me gained definition in the shadows: a coffee table, television, magazines strewn on the floor. I heard a voice from another room--a woman sobbing. She was holding a hysterical, high-pitched dialogue with herself, and my name was peppered between curses.

In seconds a picture formed in my mind, a picture drawn from the jumbled phrases of her rage. A friend of hers had shown up at her apartment very late and howling drunk, passed out, woken shortly after in a crazed, alcoholic frenzy, and kicked a hole in her bedroom wall. And that friend was me.

It was hours before dawn on New Year's Day, 1991, and I had blacked out.

Outside, the January air was crisp and brittle, the city quiet. Dawn was breaking over Washington, but I didn't stop to notice; in the past few months, days and nights had taken on a nebulous, confusing sameness, like a plane flight through several time zones. I was used to waking up and not knowing whether the sun was coming up or going down.

Despite my amazing New Year's Eve intake, I felt almost normal, and was able to walk. I felt only slightly drunk walking to Georgetown--Washington's historic booze alley--as grey dawn crept over the Potomac River. I wanted--needed--one more drink before I headed home.

The sun climbed over Georgetown's Federal-style townhouses, and I found an open saloon shortly before noon. I ordered a beer and a shot and drank them quickly. I sipped another beer and felt my spirit rise. I drank the lunch hour away, then the cocktail hour, then the dinner hour, and felt rigorously sober. I forgot all about going home or anywhere else.

As night fell, my beautiful dream quickly evaporated. After what felt like an invincible, ethereal high, I found myself instantly and insanely inebriated, as if by magic. I stumbled into the street, praying for a cab before I lost consciousness.

Hours later, I awoke lying on a pile of clothes. I was home in my bed, and I guessed by the hard orange angle of the winter sun in the woods behind my house that it was dusk. My eyes were swollen Bloody Mary red and my bones felt like old kindling. I could barely move. My disorientation was so acute I wasn't sure I could make it out of bed. I had no idea what the date was.

I tiptoed downstairs and paced on the icy linoleum tiles in the kitchen, my chest swelling with remorse and exhaustion. I had reached the end of the line, though the root of my sorrow was still elusive. My addiction was so insidious and subtle that I honestly couldn't see the glaring base of my problem--alcohol.

I hugged myself and wept, watching the dying winter sun bathe the azaleas yellow.

My mother came into the kitchen.

I turned away. "I'm so ashamed," I whispered, though I wasn't sure of exactly what.

My mother didn't seem shocked. "It's okay," she said. "Let it out." I sat at the table and sobbed quietly. She watched me, then picked up the phone.

She called a friend of the family whom I'll call John, who soon arrived clutching a small blue paperback. I suspected what the book was, and I had an idea what he was going to tell me. I had been told before, by joking friends and finally doctors, what was wrong with me. But I still had trouble believing it. The sorrow mounting in my chest was too profound, my anxiety and agitation too severe, I thought, to be chalked up to something so silly and harmless.

John laid the book on the kitchen table. I picked it up and opened the plain blue cover to the first page.

Alcoholics Anonymous.

I AM A 27-YEAR-OLD recovering alcoholic. I admit my addiction publicly because alcoholism is still a largely misunderstood physiological malady and one that provokes condemnation from a society that celebrates alcohol while denying its addictive nature. But shame does not cure alcoholism.

Biologically, alcoholism is basically a bodily adaption. Cellular adaptions in the metabolism and central nervous system--usually caused by a genetic disposition, years of relentless alcohol abuse, or both--are key to understanding the disease.

Early on, the alcoholic liver is like an engine that increases productivity when saturated with gas. Instead of shutting down when deluged with alcohol and making the alcoholic so drunk he's sick (the body's way of protecting normal drinkers from taking in too much poison), the liver sets up a highly efficient system for handling alcohol; in short, the alcoholic's body adapts. These early adaptions cause consumption to skyrocket rather than diminish, much the way a muscle worn down by exercise will grow larger and stronger.

But while the alcoholic liver adapts to the increased presence of alcohol, its ability to break down acetaldehyde, a highly toxic substance introduced when alcohol is broken down, begins to falter. This is a bizarre metabolic malfunction that may be hereditary. (Studies have shown that many children of alcoholics process acetaldehyde at half the rate of normal drinkers.)

In the cells, an abundance of acetaldehyde causes nausea, dizziness, nervous agitation, impaired cardiac function, and other withdrawal symptoms that often frighten the budding alcoholic into drinking more to numb the onrushing toxic effects--the so-called "shakes." These severe withdrawal symptoms are a clear sign that the alcoholism has progressed; the drinker no longer has normal hangovers. Meanwhile, cells in the central nervous system also adapt and function at high efficiency when the drug is present.

Thus, alcohol alone doesn't cause alcoholism. Rather, it's a combination of alcohol and how certain people react to alcohol. As journalist Nan Robertson wrote in Getting Better: Inside Alcoholics Anonymous, "Once a person becomes alcoholic, that individual cannot control the compulsion. If alcohol were the only thing that causes alcoholism, all drinkers could become drunkards."

AS THE ADDICTION progresses, the alcoholic begins to feel nervous and sick when sober. "Ironically and tragically," wrote Dr. James Milam and Katherine Ketcham in their book Under the Influence, "the alcoholic is not most sick when he is drinking, but when he stops." The need to give his cells what they have adapted to is causing round-the-clock drinking; personal troubles--arrests, loss of job, divorce--are side effects of the disease, not causes.

The alcoholic's life soon becomes a horrible race against time, balanced in the "comfort zone" between looming withdrawal and intense inebriation. Alcohol has become a life-support system; the alcoholic is like an airplane pilot who's afraid to land. He or she feels normal with a blood alcohol level that would make a non-alcoholic stumble and pass out; his physiology has changed so drastically and permanently that it's virtually impossible to change. And the pain of withdrawal is so acute it's unthinkable to stop.

After months or years, the alcoholic cell walls have been so severely damaged that they can no longer handle the large amounts of alcohol and the ensuant toxicity. They begin to reject alcohol in any quantity. The alcoholic can no longer "hold his liquor." His tolerance drops, but with no corresponding dip in the withdrawal symptoms. He suffers horribly after only a few drinks. The heart, liver, stomach, brain, lungs, kidneys, and pancreas all suffer damage beyond repair. Alcoholism, a fatal disease if untreated, has taken him.

This is a rough picture of the misery endured by millions of alcoholics every year, not to mention their families and loved ones. It's a disease that has cast its net wide over the United States, as the unsettling statistics in the 1991 Consumer Reports book The Facts About Drug Use prove: Alcohol abuse and alcoholism are responsible for up to 40 percent of general hospital admissions and traffic accidents, and for up to 200,000 deaths a year.

As important, of course, are the families of alcoholics. A recent survey by the National Center for Health Statistics and Alcohol Abuse reported that 76 million adult Americans--43 percent of the population--grew up with an alcoholic, married an alcoholic, or have a blood relative who is alcoholic. "Since the beginning of the war on drugs," noted Christine Lubinsky, director of the National Council on Alcoholism and Drug Dependence, in the October 1, 1991 Washington Post, "there has been so much focus on illicit drugs that there's been a tendency to forget that the drug that most affects people's lives is alcohol."

FOR MOST OF MY LIFE I believed, like most people, that alcoholics were either deadbeats who had no willpower or colorful, endearing clowns who went through life on a happy cloud of intoxication. I attended a university in Washington, D.C., and like many students, my social life centered around bars and bar people. By my sophomore year, I was living with a bartender and rarely paid for drinks. My heroes were all alcoholic writers: Ernest Hemingway, Jack London, Jack Kerouac, and F. Scott Fitzgerald, and I was deluded into thinking that their addictions were somehow romantic.

When I finished school in the late '80s, my drinking had clearly become a problem, though I was the only one who didn't realize it. I began to lose control when I drank, growing argumentative, nonsensical, morose, and belligerent, and went on three--and four-day benders. I could log 10 hours straight in a bar and drive home, much to the stupefaction of my friends. I began to have blackouts--past "missing time" that the alcoholic can't remember even though conscious--and could outdrink people twice my size.

Despite all this, like most alcoholics my metamorphosis had been so gradual that I hadn't the slightest idea I had become dependent. I traveled--what is known in Alcoholics Anonymous as the "geographical cure" because of the belief that a change of scenery will cure problems caused by the alcoholic. I went to Europe and got drunk there for six weeks. I passed out on the street in Florence. I closed pubs in Ireland. I sang, wine bottle in hand, from the rooftops in Paris.

Back home, things got worse. My hangovers became unbearable. I woke with shaking hands, and panic attacks ravaged my nerves. I popped tranquilizers to steady my nerves, and savagely denied that my quaking anxiety had anything to do with liquor--two clear signs of alcoholism. Suspecting a malfunction in the central nervous system, I sought help at the National Institutes of Health in Bethesda, Maryland. They tested me up and down and weeks later the doctor gave me his diagnosis.

"You're an alcoholic."

I couldn't believe it. I was only 25. The symptoms were too severe. No, he said, they weren't. I could never drink safely again. I was a dipsomaniac, a boozehound.

An addict.

I WAS FLABBERGASTED. It was like being told I couldn't walk on the sidewalk. I violently denied his diagnosis and tried experiments in controlled drinking--two more clear signs of alcoholism. The three--and four-day hangovers got worse, and my withdrawal symptoms grew life-threatening. I could finally compare myself to Jack London, but it was the London who wrote Alcoholic Memoirs: "John Barleycorn had me in a death-clutch." On June 8, 1991--the day of the Desert Storm "victory" parade in Washington--I was rushed to the hospital when I went into withdrawal after two days of heavy drinking.

Terrified and trembling, I attended my first Alcoholics Anonymous meeting. Expecting to wander into a gaggle of Bible-thumping fanatics, I found a group of compassionate people, some just as frightened as me. I listened to alcoholics, as the AA preamble states, "share their experience, strength and hope." I struggled through my first hours of cold sobriety, accepting with laughter and relief the stories of other drunks. Differences in race, class, and age meant nothing. They were just like me.

Admitting addiction to alcohol (something Jack London and Ernest Hemingway, both suicides, failed to do) was my first step to what I hope will be my rehabilitation. This meant letting go of my misconceptions and obsessions with willpower. Alcoholics spend most of their drinking days in righteous denial of everything, and the harsh honesty required to combat alcoholism is often too much for the stubborn, self-righteous drunk to handle. Many alcoholics hide behind this wall of hubris until they die, usually long before their time.

Of course, recovery isn't easy. I've had to unlearn years of habitual behavior and avoid old friends and places, and I often wrestle with depression. I now have hypoglycemia, a sugar intolerance common among alcoholics. But miraculously, the most overt ravages of addiction have tapered off. I now sleep soundly for the first time in 10 years.

Slowly, fitfully, in the last year my eyes have opened to the outside world. The sun creeps through my window in the morning--I know when it's rising and setting now--and I feel I can get through the day, or even a tough hour, without a drink. I know my life won't turn around overnight; I lost good friends, health, self-respect, and came close to death. But the darkness of that New Year's morning has gracefully begun to lift.

Mark G. Judge was a free-lance writer living in Potomac, Maryland when this article appeared.