IN THE PAST, I have treated my inebriate patients at first by isolation, coupled with the use of such drugs as seemed indicated for the relief of  physical symptoms, with a general hygienic regimen; the treatment advocated many years ago by the late Dr Norman Kerr. I was far from satisfied with the results obtained.

Without much belief in its efficacy, I next employed the treatment by hypodermic injections of atropine and strychnine, advocated by Dr McBride and practised in its best form at the Norwood Sanatorium, but the results were little, if any, better.

Both these treatments seem to owe their want of success in true inebriety to the fact that they attack the physical, to the almost entire neglect of the psychical aspect of inebriety, and of the causes underlying it.

Psycho-therapeutic methods combined with physical treatment

My experience and the experience of others, together with the testimony of my patients, convinces me that a treatment of inebriety that does not include the skilful use of psycho-therapeutic methods in their widest sense is inadequate and incomplete.

The primary cause of true inebriety is, undoubtedly, some form of defective or perverted mental equipment, and the apparent physical causes are secondary causes only, and, not infrequently, results of the inebriety and not causes at all. This being the case, the treatment of inebriety should be both mental and physical.

The first stage of the treatment should consist principally of physical treatment, by drugs, and isolation from alcohol. When the withdrawal has been accomplished, beyond a tonic treatment by drugs and general hygiene, the treatment indicated is psychical treatment first, last, and all the time.

The removal of an uncontrollable “craving”, need, or desire for alcohol can be accomplished by the first or drug stage of treatment, but no drug treatment has yet prevented the return of this craving, if and when alcohol has again been taken by the inebriate in however moderate a quantity, neither has drug treatment per se rendered the inebriate proof against succumbing to the many occasions when alcohol, from long custom, is regarded as indicated before anything else.

A very small percentage of inebriate patients, who relapse after treatment, have any intention of taking alcohol in anything but extreme moderation, when on impulse, or for some reason, adequate to them, they break through their teetotalism. Unless, however, his mentality is so altered that he can be rendered proof against giving way to what is universal custom, he stands ever on the brink of a relapse into his former inebriate state.

Every inebriate on completion of a course of drug treatment, or on his discharge from a period of residence in an inebriate sanatorium, is or should be warned that total abstinence continued for life is necessary, if he is to remain free from chronic or periodic inebriety. Not more than 75 per cent believe this warning; not more than 50 per cent, are capable of believing and appreciating the warning at its true value; not more than 25 per cent are capable of acting on the appreciated warning for a period of years.

Psycho-therapists at home and abroad have been advocating strongly in recent years the treatment of inebriety by psycho-therapeutic methods.

Dr Bérillon, of Paris, writing to me, says, that he can claim 50 per cent of cures of inebriety treated by hypnotic suggestion, all such patients having remained teetotal for years after treatment. Dr Van Renterghen, of Amsterdam, writes me, that “a lasting cure may best be  obtained in a retreat, where the medical superintendent has at his disposal the three factors, isolation, suggestion, and re-education combined.”

Dr Wetterstrand, of Stockholm, reported at least 50 per cent of cures of alcoholism treated by him by psychotherapeutic methods, and expressed the opinion that occasional renewal of treatment would have greatly increased this percentage. Dr Tokarsky, of Moscow, has claimed nearly

80 per cent of cures in patients who have freely submitted themselves to treatment. He advocates treatment by suggestion, and advises that physical treatment should be combined with psychical treatment.

Drs Woods, Lloyd Tucker, Milne Bramwell, and others in this country, have convinced themselves of the value of psychical treatment in inebriety. Neurologists, psychologists, and alienists in America are strong advocates of psycho-therapeutic methods in alcoholic and drug inebriety.

My own experience of the last three years, during which I combined psycho-therapy with the usual routine treatment of an inebriate-sanatorium is that my results have manifestly improved, that the tone prevailing in the sanatorium has noticeably altered for the better, and that my work has become of much increased interest and in every way more satisfactory, but necessarily more laborious, in that the work entails more daily individual treatment, in addition to the general routine treatment.