I am frequently confronted by the question:  Why are you doctors so down on tobacco compared to alcohol because alcohol is a lot worse?  The short answer is that moderate smoking went out with the Indian peace conventions.  The long answer is that the vast majority of smokers are addicts; only a small fraction of users of alcohol are addicted.  In one way of looking at it, everybody gets about one drink per day of alcohol because of fermentation in the intestines.  So most of society’s experience with alcohol is not with addiction.  It is unique in that it is simultaneously a drug and a food.  When yeast ferments sugar to alcohol, two grams of sugar yield one gram of alcohol.  Of the eight calories in two grams of sugar, seven persist in the one gram of alcohol.


As a young physician, I was fortunate to meet a very conscientious AA (Alcoholics Anonymous) member who offered to help with any patient for whom his services seemed appropriate.  I was skeptical of the AA dogma that alcoholism is an inborn trait, but so what, because he was a big help to my patients and to me.  Later, I read in the medical literature of a Scandinavian study of adopted children of alcoholic parents.  As adults, these children’s use of alcohol was much more similar to their biological parents than to their adoptive parents.  This points to some good advice about moderation to the children of alcoholics.


Still, the sharp distinction between problem drinkers and normal people is not entirely valid.  The social context of drinking does make quite a difference also.  Consider drinking on shore leave by Navy recruits.  Those destined to be alcoholics only become recognizable on return to civilian life.  I had an alcoholic friend in high school who stopped drinking after a serious alcohol related auto accident.  Sixty years later, he was able to have a little sherry wine with his wife without relapse to uncontrolled drinking.


Some of the very virtues of friends and relatives of problem drinkers inadvertently contribute to the problem by their ability to mitigate the consequences quietly without complaint.  In the 1950s, I wondered how a heavy drinking farmer patient managed to be so successful in spite of his drinking.  I stumbled on the answer when I made a house call to treat him for pneumonia.  As I was leaving, I stopped briefly to be friendly to a man in the barnyard whom I assumed to be the hired hand.  He turned out be the bachelor brother of my patient.  They had farmed the home place together since youth.  It was apparent that the brother was doing the lion’s share of the work virtually (and virtuously?) without complaint for decades.  Later, I learned that the sociologists call these people enablers.  Part of the art of medicine is identifying enablers out of context (in the doctor’s office) and giving them constructive counsel.  In essence, this counsel is that if some authority figure is working on straightening out the imbiber, don’t get in the way with excuses to otherwise explain some alcohol related lapse.  Especially if the authority figure is the drinker’s employer, don’t interfere.  The employer is, far and away, the most effective authority figure for this straightening purpose.


Another lesson from a patient (it is called the practice of medicine for good reason):  I had seen this man for executive exams over a period of years.  He is older than I and still healthy.  One year, he had an extra optimistic bounce to his manner, about which I commented.  He replied that his wife had stopped drinking.  It turned out that his grown children had been on his case for years that he should do something about mother’s drinking and he had always said that he could do nothing about it (most of us aren’t that smart).  Finally, to shut his children up, he arranged an appointment for the family, minus the wife, with a psychologist.  The psychologist suggested that they take turns being the “bad guy” who told mother of all recent adverse consequences of her drinking, but there was to be only one “bad guy” at a time, and my patient was appointed ex officio, permanent good guy.  Within a few months, the wife asked to go to a rehabilitation center and never drank again.


Getting back to the context of drinking:  occasionally, I have suggested with success to men who want to cut down on their intake of alcohol to try drinking only when they take their wives out to dinner.  The French have the highest incidence of cirrhosis of the liver in Western Europe.  The Italians have the lowest as do Jews in all countries.  The common denominator between Jews and Italians is that their drinking is a family ritual and the patriarch pours all the drinks.


For most of us trying to use moderation in our use of alcohol, it seems that the context of drinking trumps any inherited trait.  Incidentally, moderation is the last thing you should consider giving up for Lent.

John A. Frantz, M.D.

Chairman, Monroe City Council Board of Health

January 7, 2002



`Phi Beta Kappa Newsletter:


Here's an Idea for a new intermittent department in The Key Reporter:  Custom coining of new words by your readers.


I have a candidate word for which I know the proposed meaning.  This idea is probably spawned by my running into "explornography" a couple of years ago.  "Explornography" was coined in honor of the Mt. Everest disasters of 1996.  It refers to a person with an obscene amount of money hiring someone to take him somewhere that he has no business going. 


My need for another new word stems from planning a series of health columns about habit forming drugs, legal and otherwise, from a public health point of view.


This new word, "incarceromania", will mean spending an obscene amount of money jailing non‑violent people for possession of a small amount of (relatively non‑toxic) material for personal use.  After all, most of them would make perfectly satisfactory citizens or even parents except for being in jail.  I hope one or more of your readers will do better than "incarceromania".  When I use this incipient word publicly, I will describe its origin in a footnote giving credit to the creator by name if desired.


John A. Frantz, MD

Junior Phi Beta Kappa

Haverford College,1943