Are you a teetotaler, Dr. Chafetz?
Absolutely not. If I were a gynecologist, I could still work and not have to forgo the pleasures. The same is true of alcohol. I drink socially.
What does "a drinking problem" mean?
If you have to use alcohol to function, or when you take alcohol and it interferes with your functioning, then you have a drinking problem.
What is alcoholism?
My definition is that you don't have to use alcohol to have an alcohol problem. To me, the ax-wielding prohibitionist Carrie Nation got so preoccupied with alcohol and doing something about it that she couldn't take her mind off it. She was obsessed. That, I think, interfered with her functioning as a total human being. In a sense, she was an alcoholic.
How much do you have to drink to be an alcoholic?
I don't care about the amount. If you come to interview me and have to pop in two shots, you've got an alcohol problem. If I have to pop a couple of shots to get up to the podium, I've got an alcohol problem. I don't have to knock off a fifth and be lying in the gutter. That's crazy. Same thing with malignancy. If you've got a tumor, it doesn't have to spread all over your body before it's a problem.
Why do some people boast about the amount they drink?
We have words for that: "two-fisted drinker." It's masculine. It's one of the reasons women suffer. For years when we saw women in our clinics, there was a male-chauvinistic attitude that alcoholism was a "male" disease. We had built up a system not to notice a woman with a drinking problem. She had a double stigma—she was both "unladylike" and she was a pretty lousy woman to act that way. We crippled women with a kind of veneration. It's all part of putting a woman down by putting her up. People looked the other way until she was finally so obviously a serious alcoholic that she was way down the road by the time she came into the clinic.
What is the ratio of men to women alcoholics?
When I came into the field more than 22 years ago, the statistics showed five-and-a-half male alcoholics to one female alcoholic. The present figures show a ratio of about three-to-one—that is an 83 percent increase in the ratio of problem drinkers who are women.
What are the reasons for the increase?
Essentially, the rise is related to the changing role of women in American society, and one of the rites of passage in our society is drinking. Also, the social milieu of bars is now a mixed company of both men and women.
Do women drink more when they are just "with the girls"?
I think so, since biologically and socially we prefer to be on our best behavior with the opposite sex. To put it simply, you never get a lover being sloppy.
What kind of a woman is drunk before noon?
I would bet that such a woman is severely depressed. A lot of isolation, loneliness, with either physical, psychological or social pain. Remember, alcohol is an anesthetic drug—it makes you feel less hurt.
(To Dr. Chafetz's wife, Marion) What sort of alcohol problems do you see?
I see them at cocktail parties. I don't see many people who are alcoholics, but I do see abuse. The symptoms? Slurred, inaudible speech. Poor maneuverability. I guess I do know one alcoholic: one woman who has always been drinking before her guests arrive and is so delighted to see them because she can ask them all to have a drink with her.
Dr. Chafetz, how do you recognize a woman who is a problem drinker?
They are harder to spot than men because they have so many protective devices. For one, fewer of them work, so they drink in the home, where you can't recognize it as readily. But they do fall down and get hurt. They drink and bang up the car. They may get arrested and go to jail. They may even cause house fires.
(To son Adam) Do you see much alcohol used among your classmates?
I know this one guy who drinks 12 six-packs of beer every Saturday. That's 72 beers. He's the biggest drinker I've ever seen! A couple of years ago, when I was 15, in this very expensive school I go to, they had a headmaster who allowed anything. They had beer parties in class. That's over with now.
(To Dr. Chafetz) How widespread is teenage drinking?
Kids are almost universally using alcohol by the twelfth grade. That doesn't bother us so much, but there is an abuse pattern. Five percent of all teenagers get drunk—overdose with alcohol—at least once a week, 52 times a year. If you take just the male high school senior in the United States, 14 percent get drunk once a week, every week.
Where do they drink?
By the tenth grade, half of the kids are drinking at night in cars. Then you look at statistics of alcohol and traffic fatalities. About 40 percent of all traffic fatalities are alcohol-related. When you go from age 16 to 24, it's 60 percent.
Is this mostly beer-drinking?
Yes, but what most people don't know and are surprised to learn is that in a 12-ounce can of beer you have the same alcohol as in a cocktail. It may not whack you as hard because of the dilution factor, but you've consumed the same amount of alcohol. So if a kid says, "I'm sittin' in a car downin' a six-pack," you've got to ask yourself how you would feel as a parent if he were knocking off six martinis. We say, "If you drink a lot of beer, you drink a lot."
What are the differences between the effects of marijuana and alcohol?
Sixty-four percent of the murders and half of the felonies in this country are related to alcohol. From 25 percent to 35 percent of all rapes are related to it. The kids say, "If you turn on with grass you become introspective and examine your own navel. If you turn on with booze, you examine somebody else's navel."
How does social class relate to drinking problems?
Our statistics show that as you go up the socio-economic ladder, there is more of a tendency to be a drinker than an abstainer. When it comes to heavy drinking, there is more in the upper classes than the lower classes. If you are on an assembly line and you can't do your job, the boss is going to spot it in a hurry. If you're the editor of a magazine, a lot of people are just going to look the other way.
What about the very rich?
I've been consulted by the very rich. I won't talk about anybody specifically. But let's say the wife of a very prominent politician refuses to be chauffeured and winds up getting into problems with her car. She is getting into a bad situation without needing to. To me, as a psychiatrist, that's a cry for help that no one is listening to.
How do you approach a friend who has an alcohol problem?
If the friend had a limp or a lump, you wouldn't hesitate to say, "Why don't you see a doctor about that?" But when he or she has a drinking problem and is just as hurt and hurting, you try to ignore it. It's a guilt we feel about alcohol. But you should say, "You can get help for your problem." And if they reject what you say—if you are a good friend—you will keep trying.
No longer confined to skid row or the executive suite, alcoholism can be found with distressing frequency in the kitchen and the classroom. According to recent statistics from the Department of Health, Education and Welfare's National Institute on Alcohol Abuse and Alcoholism, one-third of the nation's nine million alcoholics are women, five percent of the high school population gets drunk once a week and liquor is much preferred by teenagers to marijuana. Monitoring these new trends in alcoholism is psychiatrist Morris Chafetz, 50, a chain smoking (he recently switched from pipes) former Harvard professor who heads the NIAAA. As a measure of America's drinking problem, the institute's annual budget has swelled from $17 million to $218 million since Chafetz became director four years ago. Dr. Chafetz sat down with his wife, Marion, their son Adam, 17, and Barnard Collier of PEOPLE to discuss the problem drinker.