ALCOHOLISM IN INDUSTRY AND FAMILY
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1179 by phosphofructokinase; but it seems that fructose-1- phosphate, produced by the action of fructokinase, can bypass this second phosphorylation and break down directly into the immediate precursors for glycerol phos- phate. The breakdown is accomplished by a special enzyme, an aldolase specific for fructose-1-phosphate, and its activity in human liver is 2-08 units per g. This value is similar to the more common aldolase on the glycolytic pathway. Thus, fructose is converted into glycerol phosphate quicker than is glucose, and the enzymes required for the conversion of fructose are present in human liver and avoid the two slow reactions in the breakdown of glucose (catalysed by hexokinase and phosphofructokinase respec- tively). Evidence is now at hand therefore to explain the observations that fructose rather than glucose favours the formation of glycerides. ALCOHOLISM IN INDUSTRY AND FAMILY RECENT weeks have seen much discussion in this country concerning alcoholism and its treatment. Tele- vision and the Press have been active; and the National Council on Alcoholism held its annual conference in London on Nov. 14 to discuss alcoholism in industry and family. The Press and the B.B.C. also gave much attention to a publication, Alcoholism in Industry, from National Lifeline-a consortium consisting of the Helping Hand Organisation, the Apex Trust, and the Circle Trust. At the conference Mr. Archer Tongue, director of the International Council on Alcoholism, said that in many countries it was widely recognised that there was a large problem, but everywhere, as in Britain, it proved difficult to convince industry itself that only the tip of the iceberg had been demonstrated. Prof. Leonard Goldberg of the Karolinska Institute, Stockholm, was able to produce cold hard facts correlating the accident-rate in industry, on the roads, and at home with the availability of alcohol and pointing to a direct link between absenteeism and problem drinking. Semantic differences in the use of " problem drinker " and " alcoholic " existed between Great Britain and Sweden, though it was clear that Goldberg’s problem drinkers really fell within the W.H.O. definition of the alcoholic, but perhaps repre- sented a diagnosis more readily accepted by industry. Sir Alistair Murray, chairman of the Glasgow Council on Alcoholism, and Mr. John Gray, director of the Council, described the first field study of alcoholism in industry ever achieved in Great Britain. This work was the start of a research programme on the incidence of the disease at various levels. Unfortunately, as the industry concerned preferred for the present to remain anonymous, the findings lost some of their impact. One startling fact emerged: at the top level in the industry, the " managers " expected an incidence of about 4%, the experimenters estimated 8%, but the actual incidence was found to be 14%. Such a figure hints that something in the nature of the industry itself had an attraction for the practising alcoholic. In this country the Institute of Directors has more than once denied the existence of a serious alcohol problem in industry. The Glasgow figures must make the Institute and its medical advisers think again. For one thing, what alcoholic patient would report his illness to industry’s medical representatives ? The Trades Union Congress recognises there may be a problem, but it feels that many other matters have greater priority. Yet the visible annual loss to industry has been put at at least E24 million and the hidden damage at a further E75 million. Dr. Beresford Davies, discussing the " ecology of a family problem ", gave some striking figures of the incidence of abnormal personalities in the spouses of alcoholics. Though his sample was small and the statistical significance was not enlarged upon, he showed that the usual image of the wife of the alcoholic as a clinging woman of masochistic nature was perhaps inaccurate, since a very high proportion of the patients he studied " escaped " from the domestic scene. Male spouses of alcoholics seemed, on the contrary, to be more caring. Dr. Beresford Davies’s thesis was later challenged as far from the usual clinical experience of those treat- ing the disease; regional differences were, of course, possible. The Cardiff approach (Adfer) to treatment was well demonstrated by Dr. Myrddin Evans who, with his large group of social workers, must have been the envy of many psychiatrists who have to manage with one or perhaps even none. The great care and support offered to the alcoholic and his family were clearly shown; and the ready and complete involvement with local authority services was underlined. The methods of the Croydon psychiatric service approach were illustrated by Dr. Clifford Salter, chairman of the N.C.A. medical committee, and members of the staff team from Pinel House alcoholic addiction unit. He emphasised that part of the unit’s philosophy in recognising the illness as a family problem was to accept that it was usually necessary to give the husband and wife, and indeed any other closely involved relative, some time to be apart, to gain in objectivity and in insight into their related problems. He doubted the ultimate value of the Adfer approach: too much material support had proved (as the unit at Warlingham had early discovered) a hindrance in increasing the alcoholic’s motivation to give up drinking for the rest of his life. The alcoholic’s worst enemy was his own ability to manipulate situations in order to maintain sources of supply. The aim in treatment both of the alcoholic and of the relative was to enable personality development of the individuals to progress to the point of interdependence, rather than dependence; to emphasise the strengths rather than the weaknesses in character formation. For many, Pinel House was the first real experience of " home " as a place where psychological needs could be and were met. Often the spouse developed the same feelings, since his or her emotional needs had been as deprived, or even more so, as those of the patient. For both alcoholic and spouse, open-ended therapeutic groups were provided after inpatient treatment was com- pleted, and any member of the team was always readily available. The conference promised better success in terms of informing and stimulating interest in areas to which the seriousness of the problem has not penetrated. Many more leaders from industry were present than attended last year’s N.C.A. conference, and it is to be hoped they will act as a catalyst to further research programmes, such as the Glasgow experiment.
Transcript of ALCOHOLISM IN INDUSTRY AND FAMILY
1179
by phosphofructokinase; but it seems that fructose-1-
phosphate, produced by the action of fructokinase, canbypass this second phosphorylation and break down
directly into the immediate precursors for glycerol phos-phate. The breakdown is accomplished by a specialenzyme, an aldolase specific for fructose-1-phosphate, andits activity in human liver is 2-08 units per g. This value issimilar to the more common aldolase on the glycolyticpathway.
Thus, fructose is converted into glycerol phosphatequicker than is glucose, and the enzymes required for theconversion of fructose are present in human liver andavoid the two slow reactions in the breakdown of glucose(catalysed by hexokinase and phosphofructokinase respec-tively). Evidence is now at hand therefore to explain theobservations that fructose rather than glucose favours theformation of glycerides.
ALCOHOLISM IN INDUSTRY AND FAMILY
RECENT weeks have seen much discussion in thiscountry concerning alcoholism and its treatment. Tele-vision and the Press have been active; and the NationalCouncil on Alcoholism held its annual conference inLondon on Nov. 14 to discuss alcoholism in industry andfamily. The Press and the B.B.C. also gave muchattention to a publication, Alcoholism in Industry, fromNational Lifeline-a consortium consisting of the
Helping Hand Organisation, the Apex Trust, and theCircle Trust.
At the conference Mr. Archer Tongue, director of theInternational Council on Alcoholism, said that in manycountries it was widely recognised that there was a largeproblem, but everywhere, as in Britain, it proved difficultto convince industry itself that only the tip of the iceberghad been demonstrated. Prof. Leonard Goldberg of theKarolinska Institute, Stockholm, was able to producecold hard facts correlating the accident-rate in industry,on the roads, and at home with the availability of alcoholand pointing to a direct link between absenteeism andproblem drinking. Semantic differences in the use of" problem drinker " and " alcoholic " existed betweenGreat Britain and Sweden, though it was clear that
Goldberg’s problem drinkers really fell within theW.H.O. definition of the alcoholic, but perhaps repre-sented a diagnosis more readily accepted by industry.
Sir Alistair Murray, chairman of the Glasgow Councilon Alcoholism, and Mr. John Gray, director of theCouncil, described the first field study of alcoholism inindustry ever achieved in Great Britain. This work wasthe start of a research programme on the incidence ofthe disease at various levels. Unfortunately, as theindustry concerned preferred for the present to remainanonymous, the findings lost some of their impact. Onestartling fact emerged: at the top level in the industry,the " managers " expected an incidence of about 4%, theexperimenters estimated 8%, but the actual incidencewas found to be 14%. Such a figure hints that somethingin the nature of the industry itself had an attraction forthe practising alcoholic. In this country the Institute ofDirectors has more than once denied the existence of aserious alcohol problem in industry. The Glasgow figuresmust make the Institute and its medical advisers think
again. For one thing, what alcoholic patient wouldreport his illness to industry’s medical representatives ?The Trades Union Congress recognises there may be aproblem, but it feels that many other matters havegreater priority. Yet the visible annual loss to industryhas been put at at least E24 million and the hiddendamage at a further E75 million.
Dr. Beresford Davies, discussing the " ecology of afamily problem ", gave some striking figures of theincidence of abnormal personalities in the spouses ofalcoholics. Though his sample was small and thestatistical significance was not enlarged upon, he showedthat the usual image of the wife of the alcoholic as aclinging woman of masochistic nature was perhapsinaccurate, since a very high proportion of the patientshe studied " escaped " from the domestic scene. Male
spouses of alcoholics seemed, on the contrary, to be morecaring. Dr. Beresford Davies’s thesis was later challengedas far from the usual clinical experience of those treat-ing the disease; regional differences were, of course,possible.The Cardiff approach (Adfer) to treatment was well
demonstrated by Dr. Myrddin Evans who, with his largegroup of social workers, must have been the envy of manypsychiatrists who have to manage with one or perhaps evennone. The great care and support offered to the alcoholic andhis family were clearly shown; and the ready and completeinvolvement with local authority services was underlined.The methods of the Croydon psychiatric service approachwere illustrated by Dr. Clifford Salter, chairman of theN.C.A. medical committee, and members of the staffteam from Pinel House alcoholic addiction unit. He
emphasised that part of the unit’s philosophy in
recognising the illness as a family problem was to acceptthat it was usually necessary to give the husband andwife, and indeed any other closely involved relative,some time to be apart, to gain in objectivity and in insightinto their related problems. He doubted the ultimatevalue of the Adfer approach: too much material supporthad proved (as the unit at Warlingham had earlydiscovered) a hindrance in increasing the alcoholic’smotivation to give up drinking for the rest of his life.The alcoholic’s worst enemy was his own ability to
manipulate situations in order to maintain sources ofsupply. The aim in treatment both of the alcoholic and ofthe relative was to enable personality development of theindividuals to progress to the point of interdependence,rather than dependence; to emphasise the strengthsrather than the weaknesses in character formation. For
many, Pinel House was the first real experience of " home "as a place where psychological needs could be and weremet. Often the spouse developed the same feelings,since his or her emotional needs had been as deprived,or even more so, as those of the patient. For bothalcoholic and spouse, open-ended therapeutic groupswere provided after inpatient treatment was com-
pleted, and any member of the team was always readilyavailable.
The conference promised better success in terms ofinforming and stimulating interest in areas to which theseriousness of the problem has not penetrated. Manymore leaders from industry were present than attendedlast year’s N.C.A. conference, and it is to be hoped theywill act as a catalyst to further research programmes,such as the Glasgow experiment.
