UNDER THE INFLUENCE

by James R. Milam

Ten of millions Americans suffer from alcoholism, yet most people still wrongly believe that alcoholism is a psychological or moral problem, and that it can be cured by psychotherapy or sheer will power. Based on groundbreaking scientific research, Under The Influence examine the physical factors that set alcoholics and non-alcoholics apart, and suggests a bold, stigma-free way of understanding and treating the alcoholic.

How to tell if someone you know is an alcoholic.

The progressive stages of alcoholism.

How to get an alcoholic into treatment -- and how to choose a treatment program.

Why frequently prescribed drugs can be dangerous -- even fatal -- for alcoholics.

How to ensure a lasting recovery.

Genres: Nonfiction, Addiction, Psychology, Self Help, Health, Disease, Science

Mass Market Paperback

First published October 1, 1981

Reviews

[Kathy · Rating 4 out of 5]

Despite its copyright of 1981, this book gives a convincing, easily-understood explanation of how differently alcohol is processed by persons who are predisposed to alcoholism. It goes on to suggest useful treatment, including complete abstinence, support and nutritional changes. I learned a lot!

[Jennifer Shirk · Rating 4 out of 5]

VERY interesting book! I particularly found the section on the importance of diet and nutrition in treatment to be extremely enlightening.

[Dennis Littrell · Rating 5 out of 5]

A trail-blazing classic of informative literature

This is a hard-hitting exposé of the institutionalized and moralist cant surrounding alcoholism and its treatment. This is a classic of informative literature, partly a fine bit of muckraking journalism, partly a public service report on the scientific findings, and partly a "how to" program to address the epidemic. Although written almost twenty years ago, this little paperback still packs a punch against an enemy that is still all too much with us. Milam and Ketcham employ a straight-forward, fact-filled, uncluttered prose style to make it clear to any but the brain dead that alcoholism is a physiological disease and NOT a psychological problem based on a character flaw and/or lack of will power. Read this and you will no longer put down the alcoholic as some kind of moral degenerate, but will recognize that if your body chemistry were a little altered, you do might well be a victim.

I can say this because both my mother and father were alcoholics, and I know the only thing that kept me from joining them was the fact that I couldn't stand the headaches and nausea that came with "overindulgence." I apparently inherited the physiologic trait common to, e.g., Italian, Jewish and Asian peoples (there's a chart on p. 45 showing susceptibility by ethnicity) protecting me from alcoholism. It wasn't due to any superior morality or advanced character development on my part that I avoided the horror of alcoholism. It's more like having black skin that protects against skin cancer. Is black skin morally superior to white skin? Or, are sickle blood cells evidence of an elevated will to resist malaria? I don't think so. Thanks to this book I can see that I was lucky: I am not an alcoholic because my internal chemistry is not disrupted by alcohol as it is with alcoholics. That's it. Pure and simple.

Unfortunately many people, including--as this book points out--doctors, psychiatrists, members of the clergy, government officials and others in a position to help or hinder, still think of alcoholism in moralist and psychological terms. As Milam and Ketcham make clear this ignorant and prejudiced attitude not only doesn't help the alcoholic and his long-suffering family, it hinders treatment. The authors are vehement on this point. On page 195, for example, they write (citing Joseph Pursch): "...physician ignorance about alcoholism and prejudice toward alcoholics are the major obstacles to effective treatment." Strong words indeed, but not surprising. Most doctors were too busy in medical school to get an education, and too busy with patients (and I must say, climbing up the hill of worldly success) afterwards to catch up. This includes psychiatrists. As the authors point out these "professionals" routinely prescribed tranquilizers and other drugs pharmacologically similar to alcohol to alcoholics, drugs to which alcoholics have a cross-tolerance, a situation that not only led to a double addiction, but was, in some cases, life-threatening.

Professionals who offer counseling and psychotherapy to alcoholics are also taken to task by the authors: "Psychotherapy diverts attention from the physical causes of the disease, compounds the alcoholic's guilt and shame, and aggravates rather than alleviates his problems" (p. 14). "A[lcoholics] A[nonymous] members are all too aware of the condescension and judgmental attitudes about alcoholism which pervade the conventional health agencies. They have been drugged with tranquilizers and sedatives, have spent expensive and fruitless years in psychotherapy, and have endured indifferent and even hostile professional attitudes toward them and their disease" (p. 132).

So-called moral leaders of public opinion are also rightly chastised for their ignorance and lofty (and phony) moral tone. Ex-California Congressman Robert K. Dornan, who is quoted as seeing alcoholism as "an absence of self-discipline," and columnist Jack Anderson, who sees alcoholism as "a personal problem" are examples cited on page 7, although if the authors had wanted to, they could have filled volumes with such inanities. Government agencies are also in the thick of the stupidity. Particularly interesting (and telling) is this bit of sly of hand reported on pages 187-188: In the government-funded Rand Report of 1976 the term "recovery" was replaced with the broader term "remission" so that it would appear that some alcoholics were in "remission" although they were still swilling down something less than three ounces of pure alcohol per day. (Three ounces of alcohol is about what you'd get in 21 ounces of table wine or more than four cans of beer!) This allowed "treatment centers which embraced this definition of remission to claim up to 80 percent success rates--even though most of the alcoholics so labeled were still drinking."

Even Alcoholics Anonymous which the authors acknowledge several times as the best recovery program in existence, could use some updating based on the reality of the disease nature of alcoholism. Step four, for example, of the12-step program ("Made a searching and fearless moral inventory") could be modified to refer to the alcoholic's conduct AFTER detoxification and the recovery process. That way a clear distinction is made between behavior caused by alcoholism and behavior over which the alcoholic now has control.

One question: Now that the new millennium is upon us, have things gotten any better? Have the medical and counseling professions gotten the word on the true nature of alcoholism, and is the disease being treated as a disease? Not being in the field, I don't know; but I suspect that Katherine Ketcham's new book (which I am going to read next) Beyond the Influence: Understanding and Defeating Alcoholism (2000) will provide the answer.

--Dennis Littrell, author of “The World Is Not as We Think It Is”

[Kinga · Rating 4 out of 5]

It gave me a better understanding of alcoholism; especially of the physical part of the addiction. It made me understand better the metabolism problems of alcoholics.

[Hearon · Rating 5 out of 5]

I read this for the first time long before goodreads even existed and I have read it at least 10 times. I recommend this book to anyone who wonders about their relationship with alcohol.

[Aisha · Rating 5 out of 5]

This book was an eye-opener for me. I vaguely understood that some people become alcoholics, but had no idea what percentage of the general population is actually alcohol dependent. Also, I did not know of the term "problem drinker" before I read this. Only around 10% of people are alcoholics, primarily because their liver does not metabolize alcohol correctly. The first few chapters detail this phenomenon, and they are a bit technical; frankly, I had to re-read them to even begin to grasp what the heck is going on in the liver. The author repeatedly emphasizes that it is counterproductive to treat alcoholism as the byproduct of mental illness, even if the individual has co-existing psychological issues. In other words, poverty and mental disease do not "turn" people into alcoholics; they are susceptible due to genetics or the aforementioned metabolic processing problem or they're not. He also points out the shortcomings of AA, which does not help people stop drinking. Rather, it helps them remain sober after they are no longer dependent on alcohol.

Milam also explains why maintaining a balanced diet that is lower in carbs and higher in protein is key to the recovering alcoholic. This element is missing from many treatment programs. Apparently, the body takes years to fully recover from alcohol dependence, and individuals may be hypoglycemic as well as psychologically fragile due to the disease's lingering effects for an extended period of time. I wondered as I read if Milam would give alcoholics a "pass" when it came to owning up to their personal responsibility after diagnosis. He does not: after diagnosis and fully understanding the ramifications of their continued drinking to their own physical and mental health as well as that of others, the alcoholic individual is morally obligated to abstain from alcohol for the rest of his life.

[John · Rating 1 out of 5]

Outdated information and highly prejudiced towards this doctor's particular take on alcoholism and more idiosyncratically, its treatment.

[Jeremy · Rating 5 out of 5]

I've read a lot of books on alcoholism—most of them tend to frame it as either a matter of moral failure or lack of self control, to be solved by either 1) God, or 2) brute force will power fueled by useless self-help platitudes.

This is one of the very few I've found that does a deep dive on what's actually going on: how your body's chemistry is changed, why the problem spirals, and why it effects some while others seem to be immune. It demonstrates how framing it as a character flaw, only to insist on recovery programs that do not work, create a self-defeating spiral of guilt, shame, and relapse that ultimately only serve the marketing strategies of companies that are financially vested in keeping you drinking.

This is a 40 year old book, and there is some obviously outdated information. It's important to approach the statistics and cited research with caution. I wish there were an updated version, or more current books that approached it scientifically as this book does. But linking alcohol cravings with hypoglycemia was an eye opener for me. Treating recovery as a hypoglycemic, as this book advised, got me 6 months sober relatively painlessly. I've sadly fallen off the wagon since and will continue researching, as I think there's still another piece to the puzzle I'm missing here, but I found this book an invaluable tool to have on hand.

[Meli · Rating 4 out of 5]

This is a great information packed booked on what alcoholism really is. How what we think we know about alcoholism is really incorrect due to years of the lack of research and education.

[Budge Burgess · Rating 1 out of 5]

There are probably still copies of this hideously awful bullshit floating about. It’s best viewed as a piece of archaeology, a record of fantasy and myth, but it has doubtless perverted the understanding of many people looking to get to grips with their or other people’s alcohol problems.
Why write this rubbish? Alcoholics Anonymous emerged in 1930s USA with its roots firmly embedded in a Right-wing, Christian fundamentalist tradition. It promoted a '12 Step' programme - the drinker had to submit to a god (now changed to 'higher power') because s/he couldn’t tackle the problem alone! AA has huge political clout in the USA, we get scores of books like this as a consequence.
According to AA, people with problems which could be traced to alcohol were 'alcoholics'. They suffered from 'alcoholism'. It was a disease (which, in the years after Crick, Franklin & Watson discovered the double-helix, would be described as ‘genetic’). The only 'treatment' was abstinence, the only 'cure' – never to drink again. Which is why we get the term 'recovering alcoholic' – you could never recover, one drink would plunge you back into Hell again. The political power of AA has made the model a hegemonic force - journalists, politicians, the general public have become conditioned to talking of 'recovery' and 'alcoholism', etc. as if these were established, unchallengeable facts.
The reality? People can and do change their drinking, can and do learn to drink differently, can and do tackle the problems which led them to drink, etc. People have problems with drink for a wide range of reasons – a one-size-fits-all genetic ‘disease’ explanation is simply inadequate. People drink from pain, fear, a sense of inadequacy, loneliness, isolation, social pressure, habit, or fun (and fun drinkers can end up in court and be sentenced to 'treatment'). The rich can drink raucously, at best their behaviour will get them referred to AA where they'll be happy to learn that it's not their fauilt, it's in their genes – homeless street drinkers get moved on, beaten up, thrown in the 'tank'.
And AA doesn't work. It's results are no better than chance. There have been complaints of abuse of females and vulnerable males by established members of groups. A huge percentage of people leave – often very quickly.
Drinking is not a disease. Patterns of alcohol use and abuse vary from society to society (there is no gene which makes you French or Italian or Moslem). Alcohol consumption and the problems which can arise reflect sociological pressures, political power and personal circumstances. We need to work from sociological models of drinking behaviours and understanding of personal circumstances, not get trapped in the simplistic 'disease' model.
And yet the authors present ‘alcoholism’ as a disease carried in the individual’s DNA and insist that there is unshakeable evidence to prove this. They state, “the accumulated evidence from all the life sciences positively indicates that physiology, not psychology, determines whether a drinker will become addicted to alcohol or not.” (p. v) And that’s bullshit, utter bullshit.
The authors’ commentary is one of moral disapproval of established moral disapproval – the ‘problem drinker’ has often been presented as a weak individual or individual exhibiting weakness, the authors tell us “the alcoholic is generally considered to be a moral degenerate who chooses a life of abasement”. (p.9) But they reject this “lack of will power and maturity” explanation (p.9), dismiss it as moralising, as a myth about “the disease”. They moralise about moralising!
There’s constant talk about disease and victims – the value of the disease model is that it excuses individual drinkers, allows them to exonerate themselves, it’s not their individual failings or problems, it’s the fault of the illness not of the individual.
It also evades any social or political causation – sale of alcohol is huge business and the breweries and distilleries, etc., have serious political clout. In many societies there is widespread social approval of and encouragement of alcohol consumption – alcohol plays a central role in social life across the world ... and it's worth more money that any of us will earn in a lifetime.
People learn to drink, people are taught to drink, they learn how to drink, they are taught to drink in a variety of social situations (from teenage groups drinking on wasteland to ‘connoisseurs’ spending thousands on a bottle of wine), … and they can learn their drinking for pathological as well as beneficial reasons, for individual as well as social reasons. People learn to drink, the consequences of their drinking can be problematic, and often, the more money they have, the fewer the problems they’re likely to face.
But this book prattles on about victims and disease – “Addiction to alcohol is primarily physiological.” (p.12) The authors then indulge themselves in a sweeping generalisation – “Alcoholics have the same psychological and emotional problems as everyone else before they start drinking. These problems are aggravated, however, by their addiction to alcohol.” (p.12) Ludicrous piece of logic – the so-called ‘alcoholic’ is an ‘alcoholic’ from birth, and remains an ‘alcoholic’ even if s/he never ever has an alcoholic drink … their ‘illness’ or genetic problem processing alcohol is only discovered once they discover they have problems with alcohol. Self-fulfilling prophecy! Meanwhile, other people who don't carry this debilitating gene can face the same problems as the 'alcoholic' but somehow cope better because they don't have the genetic flaw! Logically, that would suggest that some people cope with problems better than others ... that it might be worth investigating a 'talking cure' rather than being trapped in an abstinence one?
People drink because it’s fun, it’s social, it’s sexy, it’s relaxing, it anaesthetises them to worries and problems, it gives them confidence, energises them … sedates them, eases tensions, relieves pain – there are as many reasons for drinking as there are drinkers … and problems occur because of their misuse of the alcohol and the severity of the problems they face, not because they’re genetically programmed to have problems.
But we get the authors claiming that responsible drinkers who never have a problem with alcohol because they doon't drink can actually be alcoholics because of the nature of their disease! (p.13) Alcoholics don’t need help, they simply can’t drink normally – total abstinence is essential, total abstinence is the only treatment … they have to learn to become ‘addicted’ to abstinence, to compliance with a rigid set of behaviours.
Simply describing someone as an ‘alcoholic’ is a labelling exercise – it defines the origins of the person’s problems as beyond their ability to change, it doesn’t help to investigate the causes of their problems or the nature of the stresses they experience, it doesn’t suggest the best response, the best ways to tackle their problems. Regardless how trivial the offence, it’s a life-sentence with no hope of parole.
“Psychotherapy diverts attention from the physical causes of the disease, compounds the alcoholic’s guilt and shame, and aggravates rather than relieves his problems.” (p.14)
The authors inform us that concepts of “addictive personality” have been discredited – what they don’t point out is that few schools of psychology would ever attach any currency to notions of “addictive personality”, most would simply reject the label. I see this lack of awareness of psychology as informative.
Alcoholics, the authors argue, start drinking the same as anyone else … but they can’t handle alcohol, they can’t stop themselves. Alcoholism is a physical complaint, it’s roots are physiological. Therefore, different races respond differently to alcohol! “Jews and Italians have low alcoholism rates … Native Americans have extraordinarily high rates”. (p.43) There are sociological reasons for different social groups having different patterns of drinking – low rates of alcohol abuse in Moslem societies are not attributable to DNA, etc. etc.
I could go through this tome page by page and challenge the arguments and conclusions line by line. Can I just conclude by suggesting that I hope I’ve raised enough doubts and questions for anyone reading this appalling book to bin it and look elsewhere for help.
If you’re having problems through alcohol, or if you recognise that you’re using alcohol to anaesthetise yourself to other problems which need tackling – talk to somebody, go find someone who’ll help you cope (and someone who won’t simply pocket your money while convincing you of their own pet beliefs … there are large numbers of venal, incompetent and predatory therapists out there, don’t let them take you for a sucker).

[Lisa · Rating 5 out of 5]

Alcohol will ruin just about every organ in your body if taken for long enough and in large enough quantities, and this book is very clear about the science of that process. The author’s bête noire is that so many medical professionals and members of the public still act like alcoholism has some moral taint or believe that it is psychological in origin instead of acknowledging it as the disease that it is. Alcoholics have a genetic abnormality that causes them to process alcohol differently from other humans. This abnormality in processing actually causes changes in the alcoholic’s cellular structure, which in turn causes the physical addiction. The typical alcoholic has no chance of overcoming their dependence without treatment. The alcoholic must then maintain permanent sobriety in order not to activate the disease process again.

You can be a “problem drinker” without actually having the genetic abnormality that characterizes the genuine alcoholic. Dr. Milam tries to explain how to tell which kind you are dealing with, but that’s hard to do in the early stages when the alcoholic seems to be coping with booze more or less like everyone else. By the time their alcoholism is obvious, a lot of damage has been done already and the withdrawal process will be more difficult. I was interested to read that alcohol is the only drug that can also be classified as a food. Therefore any good treatment facility will include a nutritional aspect, likely a hypoglycemic diet and vitamin regimen customized to alleviate deficiencies. Along with other less pleasant detox stuff. And the good facility will keep the person longer than 2 weeks, even though the alcoholic may think they are cured and ready to leave at that point. This book is not a very happy read, but it is well-organized, interesting, and informative.

[Kristin Aker Howell · Rating 5 out of 5]

I learned from this book that one in ten people can have a physical addiction to alcohol. People with this genetic predisposition, this allergy to alcohol, can easily develop the disease of alcoholism, which is chronic, progressive and fatal. This book changed my understanding of alcoholism. Now I can more easily recognize the symptoms of alcoholism, and find empathy for those going through it. I encourage anyone who knows more than nine people to read this well-organized and researched book – at least skim it – because chances are good you know someone who is dealing with this disease. Most alcoholics and families of alcoholics suffer in silence because many of us, me included, have many misconceptions. Education will help us all identify, and therefore treat and recover from, this disease much earlier in its progression. Ages 15 and up.

[Tricia · Rating 3 out of 5]

I would love to see this book updated with more current research. This book was written in 1984.
While I learned a lot about alcoholism reading this book, I was constantly asking myself if the research still supported some of the claims or if evidence has shifted since this book was published. For instance, I have read that AA has mixed results of effectiveness when it has been studied using rigorous methods. Motivational Interviewing is a tool that was developed after this book was written and been shown to be a highly effective in supporting addicts to seek treatment (Rollnick and Miller). It would be great to know what other options have become available that are evidence-based. This book was well written and easy to read.

[Anu · Rating 4 out of 5]

Speaking of books that age well, this one is nearly as old as I am, but looks much better 😬 Alcoholism is a scourge in modern USA but it’s amazing how socially acceptable, nay, how socially encouraged, it is. The book has solid research backing its claims on how difficult deaddiction can be, the importance of diet in recovery and the travails of finding social support. Good overview of symptoms, causes and recovery options. More fact focused than narrative focused, but very comprehensive anyway.

[Yamille · Rating 5 out of 5]

This is a cut and dry factual book about dealing with the disease. I think it appeals very much to someone who is interested in scientific facts in a reader friendly book. I think it also fosters empathy for someone who is dealing with the disease directly or for future therapists wanting to work with substance abuse population.

[Shawn Lowe · Rating 4 out of 5]

This book is full of great information about what alcoholism really is. I don't necessarily agree with some of the things they say about AA, but the physiological information is spot on.

[Bailey · Rating 5 out of 5]

I have been reading and thinking about sobriety and alcoholism every day for the past five years, and what I enjoyed about this book was that I was learning something new on almost every page. It achieves so much that most "quit-lit" does not - ruthlessly honest, well-written, useful, and compassionate.

This book is an excellent primer on why most efficient treatment methods and professionals are passionate about the premise that alcoholism is a disease - a tangible, physiological difference between an alcoholic and a nonalcoholic that makes the alcoholic insensitive to the physical cues that keep one from drinking heavily and drinking often.

My confession is - gasp! - I have felt conflicted about the belief that alcoholism is a disease. My own personal experiences support the idea that there was something categorically different between myself and my nonalcoholic peers from my very first drink. What an alcoholic needs is obvious: no more alcohol. Still, recovery is deeply behavioral in its very nature, just as drinking is technically behavior. The genetic differences that so profoundly influenced me to drink excessively are still present and I am at a higher risk to become addicted again than nonalcoholic folks. Still - I am in no way diminishing that for this reason I must stay committed to complete abstinence to be healthy, but it feels strange to consider myself diseased five years into recovery.

So yes. I have never fully understood the sometimes dogma-like attitude that alcoholism is as disease. If you have questions why this is such a prevailing theme among most experts, though, this is absolutely the right book for you. I am well-read on this subject, but no other book has clearly outlined 1) why alcoholism should be considered a disease; 2) exactly how an alcoholic's body is different - pre-addiction, during addiction, and during recovery; and 3) how this insight should influence treatment and prevention going forward.

I wish I had read this book earlier on in my recovery - I felt perpetually ill for months afterwords and seemed to catch every single cold going around town, and though my doctor, sponsor, and research all agreed that it was normal and to be expected, they had very little to tell me about why that was or what to do about it. This book reviews extensive research and pares it down beautifully to a brief user's manual.

It also is an extremely powerful and damning analysis of the havoc alcohol wreaks on your body, and why abstinence is the only treatment for the alcoholic. If you want to make recovery feel more like heaven and less like hell, it is by reflecting on the painful nature of inebriation and addiction versus the pleasure, joy, and growth that being sober has to offer. One of the key moments in my own recovery was an exercise that started with me imagining life 1 years, 5 years, and 10 years into the future - what that future would look like if I continued to drink, versus what that future looked like if I committed to abstinence (that exercise is detailed in the 30-Day Solution to Sobriety, by Anderson and Canfield). This book will help you move on from agonizing over how amazing a glass of wine would feel in the here and now. Instead, you'll find yourself thinking of the long-term itemized bill that glass of wine would cost you - from the shaky hands and bruised soul the next morning to the future diagnoses you are going to get some day - pancreatitis? Cirrhosis? Cancer?

It will also help debunk many of the beliefs that haunt one long after the last drink - I don't perform as well, I'm not as funny, I don't have as much fun, I'll feel anxious, I'll teach myself to drink "normally". This book cites empirical studies to demonstrate that for the most part, these changes in behavior and mood short-lived and overwhelmingly an illusion, particularly for the alcoholic.

So! If my long review hasn't scared you off, I would recommend this book to anyone who:

-does not understand or has questions about the premise that alcoholism is a disease
-is in the early or middle stages of addiction or any stage of recovery (my goodness, how I wish someone had given me this book in the first months)
-needs accurate and up-to-date guidance on the general medical and nutritional needs of an addicted or recovered alcoholic - this is surprisingly hard to find, even from one's own doctor!


And here are my caveats:
-it is brief - this should not be your only resource for something as hefty as alcoholism and recovery
-it has very little to say about treatment that the alcoholic is seeking on their own
-it is not a helpful guide for the spiritual/mental nourishment and healing that I believe is a crucial part of recovery - I recommend AA, The 30-Day Solution, and/or treatment from a clinical psychologist

[Katie Gee · Rating 4 out of 5]

This has been the most helpful book to learn about the 3 states of alcoholism, its symptoms, effects, prejudices, and solutions. Learning about how alcohol changes mitochondria helped me understand what I now see as unrelated physical and psychological problems as interconnected symptoms of liver and brain cell malfunction. A 4-week long in-patient treatment by med. staff, follow up treatment, and strict nutritional regimen to offset malnutrition caused by ADH toxins in liver that prevent nutrition to be eaten and absorbed are key to recovery. Some chapters seemed a bit repetitive and quoting misinformation from the 1970s to prove newer research seemed unnecessary, but overall it was informative and hopeful.

[John Steinhauser · Rating 5 out of 5]

A readable and essential resource for anyone affected by alcoholism (whether the alcoholic, his friends and family, or professionals who regularly interact with alcoholics).

Grounded in decades of proven research, this book dissolves stigma and myths and helps the average person understand the physiological workings of alcoholism and the appropriate treatment for it.

If you are an alcoholic or know an alcoholic, you’ll find this book shockingly accurate and a critical resource for guidance and hope.

[Dwayne · Rating 5 out of 5]

This book explains the phenomonon alcoholism.
And is vital to understanding addiction inparticular alcoholism.
So I give it 5 stars, depending on the reader it seems rather technical,
It literally save me from another relapse many years ago, which is
the same as saying it saved my life.

[Arthaey · Rating 4 out of 5]

Informative if you've only ever "learned" about alcoholism from pop culture, stereotypes, and judgmental assumptions.

Minus 1 star because it gets rather repetitive after a while.

[Milissa · Rating 5 out of 5]

Since the book is so old, I'm not convinced the stats are accurate...I think it's a lot more prevalent than most acknowledge. But human behavior doesn't change...so the descriptions are spot on. I learned a lot. The author makes a big effort to distinguish between an alcoholic and problem alcohol behavior. Scientifically, that is important...but in terms of life consequences and the fall out, the distinction seems unimportant.

Side note...When did drinking become so pervasive? It's so common and so accepted and "normal" pretty much all the time. Breakfast, lunch, dinner, weekday, weekend, normal day, holiday, after exercise...day/time doesn't seem to matter...I'm almost always the odd one for participating in the event but choosing to do so without a drink. It's very rare for me to receive any kind of invitation that doesn't revolve around alcohol. And I don't mean a social event where people will probably have a drink...I mean having a drink is the reason for the invite. For example, people don't say to me "Hey, let's catch up over lunch/dinner." In that case, I know some folks will drink wine/beer with their food. No big deal. The typical invite is more like "Hey, let's go to the new restaurant to try their beer." I don't drink...my drinking habits aren't new...my friends know this...and yet it's still the only way they seem to know to extend an invite. I don't make a big deal of it...I'm sensitive to the negative effects of drinking (obviously, since I read this book) and I know the intent doesn't match the words...it's just an observation regarding what seems to be the cultural norm everywhere.

[Jennifer Oswald · Rating 4 out of 5]

Just trying to understand more,,,praying my boyfriend,,well friend for now,, can find himself,,,I'm there for him but cannot be with him right now...I have to see for myself, they say see how the person stands in a year,, well, that's a long time but I can wait, there is alot more than just the fact that they had a problem with drinking, most of the time it isn't the alcohol itself, it's the mind and alcohol just distorts perseption, will, drive,,, it hurts, he said he doesn't ever want to hurt me again, or drink, but I have to see, from a distance,, we were together 3 years so I have to see,,, I will say the book helps,,, and I want to find a few more,,, any suggestions.....Opened my eyes though,,,,,

[Kristin Stoner · Rating 4 out of 5]

This book was a real eye-opener. So much wonderful and helpful information, that it is hard to know how to say READ THIS with enough emphasis if you or anyone you know is either an alcoholic or a alcohol abuser. (This book taught me the difference.)

I agree with the review below that an update to this would be fascinating. Considering the endless advances in medicine since this publication in 1981, I'm sure the information would only be strengthened.

I wish I would have read this book years ago.

The only reason I did not give it five stars is because I want some updated information. New edition please!

[Tod Jones · Rating 4 out of 5]

This book is packed with information that is presented in an easily understood way. It takes the disease model as its starting point, but whether you adopt that model or not, most of what you will find in this book is worthy of careful consideration.
I've given this book 4, instead of 5, stars only because it is incomplete---having been published nearly 30 years ago---and requires a supplement. The good news is that such a supplement has been published under the title Beyond the Influence.

[Jesse Schexnayder · Rating 4 out of 5]

This will likely change your perception of alchohol. It makes sense that the body would undergo significant changes on the cellular level in order to process alochol as a food. When the inevitable breakdown of the human body occurs, it should not be surprising that many alcoholics enter what can only be described as a death spiral.

The book shows its age with references to President Carter and the like, but the information regarding the disease of alcoholism remains timely.

[Andrea]

If you have an alcoholic in your life and can't understand how or why he/she became that way, or why they can't control it, this book explains the biochemical and metabolic changes that occur in some people under the influence of alcohol in clear language that helps you see that it isn't really their fault. Priceless information.

[Matt Bulvony · Rating 4 out of 5]

This book certainly explains a lot about the impact of alcohol on the body and mind of the alcoholic but I think I must reread it to really grasp what he is saying about the evidence for the disease concept of alcoholism. What he said seemed to make sense in my experience. I guess I'm not really finished with this book.

[Karen Riley · Rating 5 out of 5]

Hooray! The actual science underlying alcoholism

REALLY like the straightforward scientific explanation of the various physiological processes that cause alcoholism. A VERY good book for alcoholics and nonalcoholics alike to gain understanding of this potentially devastating physiological disease.

[Shelly Curtain · Rating 4 out of 5]

A great book for understanding the physiology of addiction. The examples of the Skid Row bum and other lifestyles are a little antiquated and sexist, but this book is worth reading if you want to know what happens to your liver cells after too many prolonged alcohol baths.