EM Jellinek on Alcoholism

EM Jellinek did the initial research that gave us the disease concept of alcholism. He used very flimsy research and came up with the foundations of how we view and treat alcoholism today.

Introduction below courtesy of Wikipedia.

EM JellinekElvin Morton “Bunky” Jellinek (1890–1963), E. Morton Jellinek, or most often, E. M. Jellinek, was a biostatistician, physiologist, and an alcoholism researcher. He was born in New York City and died at the desk of his study at Stanford University on 22 October 1963. He was fluent in nine languages and could communicate in four others. Addiction researcher Griffith Edwards holds that, in his opinion, Jellinek’s The Disease Concept of Alcoholism was a work of outstanding scholarship based on a careful consideration of the available evidence

Jellinek coined the expression “the disease concept of alcoholism“, and significantly accelerated the movement towards the medicalization of drunkenness and alcohol habituation.
Jellinek’s initial 1946 study was funded by Marty Mann and R. Brinkley Smithers (Falcone, 2003). It was based on a narrow, selective study of a hand-picked group of members of Alcoholics Anonymous (AA) who had returned a self-reporting questionnaire. Valverde opines that a biostatistician of Jellinek’s eminence would have been only too well aware of the “unscientific status” of the “dubiously scientific data that had been collected by AA members”

EM Jellinek is either an eminent scholar and researcher (see above) or a base charlatan (click here). People have differing opinions. Most of the criticism and acclaim come from his study of alcoholism and developing the disease concept of alcoholism. The disease concept of alcoholism is much more controversial than the average person knows.

Here are the conclusions Jellinek made in writing. I didn’t put this in my own words because these definitions are important and I did not want to “fiddle around” with them.

Jellinek Species of Alcoholism

Jellinek listed five. Strangely, not all of these are considered to be a disease. Some he considered more psychological in nature.

represents a psychologicall dependence on alcohol. There is no loss of control and the person can abstain whenever they want. The most noticeable sign is that if anything goes wrong, the Alpha alcoholic will start looking for a bottle. To many, this is called problem drinking.

is where you aren’t dependent on alcohol but, you have medical problems created by it. This usually happens to people who live where there is lots of alcohol and very poor nutrition. Hundreds of years ago alcohol aboard a ship would have been plentiful but, nutrition would have been terrible. These sailors would have been Beta Alcoholics.

is distinguished by cellular changes, an increase in tolerance, and withdrawal when alcohol isn’t consumed. There is physical and psychological dependence. This is the alcoholism that goes through the four phases listed on the phases of alcoholism page. This is the type that AA talks about.

has both physical and psychological dependence. There is no loss of control once they start drinking but, they need to drink everyday of withdrawal sets in. Some of my oldest friends are like this.

is the binge drinker. It wasn’t studied in detail but, Jellinek believed it wasn’t just the relapse of the Gamma Alcoholic.

jellinek disease of alcoholism

Jellinek Phases Of Alcoholism

In the pre-alcoholic phase, the individual’s use of alcohol is socially motivated. However, the prospective alcoholic soon experiences psychological relief in the drinking situation. Possibly his or her tensions are greater than other people’s, or possibly the individual has no other way of handling tensions that arise. It does not matter. Either way, the individual learns to seek out occasions at which drinking will occur. At some point the connection is perceived. Drinking then becomes the standard means of handling stress. But the drinking behavior will not look different to the outsider. This phase can extend from several months to 2 years or more. An increase in tolerance gradually develops.

The road to alcoholism begins when the drinking is no longer social but becomes a means of psychological escape from tensions, problems and inhibitions. Although the eventual problem drinker is still in reasonable control, their habits begin to fail into a definite pattern:
1. Gross Drinking Behavior:
They begin to drink more heavily and more often than their friends. “Getting wasted” becomes a habit. When drunk, they may develop a “big shot” complex, recklessly spending money, boasting of real and imagined accomplishments, etc.
2. Blackouts:
A “blackout,” temporary loss of memory, is not to be confused with “passing out,” or loss of consciousness. The drinker suffering from a
blackout cannot remember things they said, things they did, places they visited while carousing the night before – or for longer periods. Even a social drinker can have a blackout. With prospective alcoholics, the blackouts are more frequent and develop into a pattern.
3. Gulping and Sneaking Drinks:
Anxious to maintain a euphoric level, they begin to pass off drinks at parties and instead slyly gulp down extra ones when they think nobody is looking. They may also “fortify” themselves before going to a party to insure their euphoria. They feel guilty about this behavior and skittishly avoid talking about drinks or drinking.
4. Chronic Hangovers:
As they grow more and more reliant on alcohol as a shock absorber to daily living, “morning after” hangovers become more frequent and increasingly painful.

Until now, the problem drinker has been imbibing heavily but not always conspicuously. More important they have been able to stop drinking when they so choose. Beyond this point, they develop the symptoms of addiction with increased rapidity.
5. Loss of Control:
This is the most common symptom that a drinker’s psychological habit has become a physical addiction. They still may refuse to accept a drink; but once they take a drink they cannot stop. A single drink is likely to trigger a chain reaction that will continue without a break
into a state of complete intoxication.
6. The Alibi System:
Their loss of control induces feelings of guilt and shame. So they concoct an elaborate system of “reasons” or excuses for their drinking – “The pressure on my job is too hard to take,” or “My wife is constantly yelling at me,” or “I’m a little shaky, a drink will calm my
nerves.” They hope these excuses or rationalizations will justify their behavior in the eyes of their family or associates. In reality, the alibis are mostly made to reassure or bolster the drinker into thinking that their behavior is acceptable.
7. Eye-Openers:
They need a drink in the morning “to start the day right.” Their “morning” may start at any hour of the day or night. So an eye-opener is, in fact, a drink to ease their jangled nerves, hangover, or feelings of remorse after any period of going without a drink; as an example: while they were sleeping. They cannot face the upcoming hours without alcohol.
8. Changing the Pattern:
By now, the drinker is under pressure from their family, friends, and/or employer. They try to break the hold that alcohol has on them. At first, they may try changing the kind of drink; from beer to whiskey or from wine to beer. That does no good. Then they may set up their own rules as to when they will drink and what they will drink: only three martinis on weekends and, of course, holidays. They may even “go
on the wagon” for a period of time. But one sip of alcohol and the chain reaction starts all over again.
9. Anti-Social Behavior:
They prefer drinking alone or only with other alcoholics, regardless of the other person’s social level. The drinker believes that only these other people can understand them. They brood over imagined wrongs inflicted by others outside this pale, and think that people are staring at them or talking about them. They are highly critical of others and may become violent or destructive.
10. Loss of Friends, Family or Job:
Their continuing anti-social behavior causes their friends to avoid them. The aversion is now mutual. The members of their family may become so helplessly implicated that their spouse leaves them (“to bring him to his senses”). The same situation develops between their employer and fellow workers. And so, they lose their job.
11. Seeking Medical Aid:
Physical and mental erosion caused by uncontrolled drinking leads them to make the rounds of hospitals, doctors, psychiatrists, etc. But because they will not admit the extent of their drinking, they seldom receive any lasting benefit. Even when they do halfway “level” with the doctors, they fail to cooperate in following their doctor’s instructions and the result is the same.

Until they have reached this point, the alcoholic has had a choice: to drink or not to drink — the first drink. Once they took the first drink, they then lost all control. But in the last stages of alcoholism, they have no choice: they must drink.
12. Benders:
They get blindly and helplessly drunk for days at a time, hopelessly searching for that feeling of alcoholic euphoria they once appreciated. They utterly disregard everything – family, job, food, even shelter. These periodic flights into oblivion might be called “drinking to escape the problems caused by drinking.”
13. Tremors:
In the past, their hands may have trembled a bit on “mornings
after.” But now they get “the shakes” when they are forced to abstain, a serious nervous condition which racks their whole body. When combined with hallucinations, they are known as the D.T.’s (delirium tremens), and are often fatal if medical help is not close at hand. During and immediately after an attack, they will swear off alcohol forever. They nevertheless come back for more of the same.
14. Protecting the Supply:
Having an immediate supply of alcohol available becomes the most important thing in their life – to avoid the shakes, if nothing else. They will spend their last cent and, if necessary, will sell the coat off their back to get it. Then they hide their bottles so there will always be a drink close at hand when they need it – which can be any hour of the day or night.
15. Unreasonable Resentments:
The alcoholic shows hostility toward others. This can be a conscious effort to protect their precious supply of alcohol, be it a half-pint on the hip or a dozen bottles secreted about the home. It can also be the outward evidence of an unconscious desire for self punishment.
16. Nameless Fears and Anxieties:
They become constantly fearful of things they cannot pin down or describe in words. It is a feeling of impending doom or destruction. This adds to their nervousness and further underscores the compulsion to drink. These fears frequently crop up in the form of hallucinations, both auditory and visual.
17. Collapse of the Alibi System:
They finally realize that they can no longer make excuses nor put the blame on others. They have to admit that the fanciful “reasons” they have been fabricating to justify their drinking are preposterous to others and are now ridiculous even to them. This may have occurred to them several times during the course of their alcoholic career, but this time it is final. They have to admit that they are licked; that their drinking is totally out of control and is beyond their ability to control it.
18. Surrender Process:
Now, if ever, the alcoholic must give up the idea of ever drinking again and be willing to seek and accept help. If at this point the alcoholic is unable to surrender, all the sign posts point to custodial care or death. If they have not already suffered extensive and irreversible brain damage, there is a strong likelihood that some form of alcoholic
psychosis will develop. The amnesia and confabulation of Karsakoff’s syndrome and the convulsions and comas of Wernicke’s disease are possibilities. Death may come in advanced cases of cirrhosis of the liver, pancreatitis, or hemorrhaging varices of the esophagus. Or they may arrange their own suicide. After all, the suicide rate among alcoholics is three times the normal rate of self-extermination.
(Phases copied in full from Distance Learning Center for Addiction Studies)

He proclaimed this from a 1946 study of the AA men.

Progression curve of addiction (alcoholism)

Jellinek model of alcoholism

From what I can tell Jellinek knew nearly as much about the disease of, and progression of, alcoholism in 1946 as we do today.  And today we have huge government agencies like NIAAA, SAMSHA, and NIDA to spend piles of money on research.  But at least we have a 20 billion dollar a year industry to show for it. Of course, it has less than a 5% success rate.

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