Perspectives - Vol. 4, No. 2 - The Morality of Alcoholism - Page 2 of 2

Gary S. Stofle

This article is continued from Page 1

Argument #2. Aristotle clearly delineates when a person is not morally responsible for his or her actions.(13)  He uses two concepts to judge whether or not a person should be held morally responsible for an action. Both concepts are applied to the moral/physical dualism of responsibility. The reader should keep in mind these two concepts are not use by Aristotle in regards to alcoholism; Aristotle holds the drunkard morally responsible for actions because he considers the act of drinking to drunkenness as voluntary.

Aristotle describes two basic types of actions - voluntary and involuntary. He further states:

...it is only voluntary actions for which praise and blame are given; those that are involuntary are condoned, and sometimes even pitied.... It is generally held that actions are involuntary when done a) under compulsion or b) through ignorance.(14)

Aristotle further divides ignorance into avoidable and unavoidable ignorance. The agent is morally responsible if he is avoidably ignorant; he is morally excusable if he is unavoidably ignorant. An example of avoidable ignorance is a person who shoots another with a gun saying "I did not know the gun was loaded".  He should have avoided ignorance by taking the time to check the gun. He would be held morally responsible. An example of unavoidable ignorance would be if a person invites another for a ride in the car and during the drive, the car is hit by another car. The driver was unavoidably ignorant of the fact that they were going to be involved in an accident. There is no way the driver could have informed himself about the accident before he asked his friends along. He is unavoidably ignorant and thus morally excusable.

The alcoholic is unavoidably ignorant of the presence of a predisposition to become alcoholic. As of this writing, there is no test to determine whether or not a person will become alcoholic. There is absolutely no way alcoholics in treatment centers today could have informed themselves concerning whether or not they would become alcoholic when they first drank. Along this line of thinking, several facts need to be kept in mind. One is the fact that most drinkers do not become alcoholics, in fact, most people do not drink excessively. The statistics used to show that ten percent of the drinkers drink half of all the alcohol that is consumed. This fact would imply less obligation for the potential alcoholic to inform himself of his predisposition to alcoholism if a tests were available. Another fact is that in our society, drinking is a normal adult activity. The vast majority of people drink at some point during their lives, unless they are prohibited to by their religion or some diagnosed medical disorder.

That the alcoholic is unavoidably ignorant of his disease seems also to be true because of the logical absurdity of the reverse (that he takes his first drink knowing he will become an alcoholic). In my experience with alcoholics in a variety of settings, I have yet to hear an alcoholic say, "A yes, I knew I was going to become an alcoholic, lose my wife, children, job and almost my life; end up in jail filled with shame and disgust and eventually end up in treatment."

Aristotle states an action is involuntary and morally excusable if it is done under irresistible compulsion. The alcoholic, in the midst of the disease, eventually is ruled by the compulsion to drink. Father Martin puts it eloquently in his film, Chalk Talk, when he states; " The alcoholic drinks the way he does because he cannot not drink that way. " (15)  He goes on to say, when a person came to him aghast that the mother went to her daughter's graduation drunk, ;" of course she did, that's the problem!" That women's compulsion to drink was irresistible - no other explanation seems possible.

The alcoholic is morally excusable for actions during active alcoholism because of unavoidable ignorance. If he knew before the disease became evident that he would become an alcoholic, he could have chosen to do other than what he did. Once he did become aware of the problem, he was under irresistible compulsion to continue to drink. The only manner in which irresistible compulsion can be dealt with is through treatment and AA. While the alcoholic is morally excusable for actions, he is still physically responsible. Increased physical responsibility helps motivate the alcoholic to get into treatment.

Argument #3: Utilitarianism.  This argument deals with the blameworthiness of the alcoholic. The proponents of the theory of utility are concerned with results - that action which brings the greatest good or the least amount of harm for the most amount of people is the right action. Actions are judged on their consequences; if the consequences are good, then the action is good. The Utilitarians believe that blaming is an action people take in order to change other's behavior.

.....blaming is a practice which is justified only by its results in changing behavior. We blame people in order that they will refrain from doing similar acts in the future, and we praise them in order to reinforce similar behavior in the future. When these devices do not have these effects, as often happens, we should refrain from using them. (16)

The Utilitarians make several distinctions when talking about blame. The separate the action from the agent, and also separate the action of blaming from the original action. The rightness or wrongness of both the original action, and the action of blaming, are judged by the utilitarian.

If Mr. A. is a social drinker and after a night of drinking he hits Mr. B's parked car, it would be right to blame Mr. A. for that wrong action (hitting the car) because it could very well result in Mr. A. changing his behavior (because Mr. A is a social drinker, he could stop drinking solely because of the consequences of his behavior while drinking).   However, if Mr. C., who is an alcoholic, hit Mr Bs car while drunk, it would be wrong to blame Mr. C because blaming him could not result in changing his behavior. Thus, blaming the alcoholic is immoral in itself from a utilitarian point of view, particularly because blaming the alcoholic can have harmful consequences, namely causing increased anxiety in the alcoholic which causes an increase in drinking. The most frequent blamers of alcoholics are co-alcoholics. It appears co-alcoholics should not be held morally responsible for blaming alcoholics for their actions, because the co-alcoholics' act of blaming is a symptom of their issues related to being affected by the alcoholic's drinking.   The co-alcoholic cannot not blame the alcoholic, until he or she understands the disease of alcoholism, and develops other skills beyond blaming for coping with the alcoholic. These skills can be developed through treatment and using the principles of Alanon.

The worker must be sensitive to the fact that blaming often does not involve words at all; one can have an attitude of blame. It is easy for an alcoholic client/patient to sense when a worker has an attitude of blame. (17)  Newly detoxed alcoholics are often more aware than they have been in years. They are very sensitive to how others are presenting themselves. A cold handshake, an aloof or disgusted look, are very powerful messages to the alcoholic. The worker with an attitude of blame will be unable to connect with the alcoholic. This may account for the fact that professionals who are also recovering alcoholics are often accepted more quickly than non-recovering professionals by the alcoholic. The recovering professional is most instances will not have an attitude of blame towards the alcoholic and so can easily connect with him or her (although it must be said that is not always the case). However, any worker with an appropriate attitude can connect with the alcoholic. The attitude the worker must develop is one of not blaming, but at the same time holding the alcoholic physically responsible.

The alcoholic's actions are often wrong because of their harmful consequences, by a utilitarian standard. Thus, alcoholics must be held physically responsible for their actions. Society demands that whatever the case, members of society must be in some way responsible for their actions. At the same time, blaming the alcoholic for wrong actions is wrong in itself, as it has no good, and usually harmful, consequences.

Argument #4: Alcoholics Anonymous. The last, but most certainly not the least, argument for the moral/physical a dualism of responsibility in alcoholism in the teachings of AA. Members of AA greet new members with acceptance rather than blame or judgment. But along with this accepting attitude, the Twelve Steps suggest alcoholics need to take responsibility for their behavior. (18)  Alcoholics need to admit and accept that their lives has become unmanageable and takes responsibility for the harm they have done to others by making amends.

Recovery from alcoholism through treatment and Alcoholics Anonymous sets the stage for righting the moral balance sheet. The wrong actions of the past are owned by the alcoholic and righted by direct amends to persons harmed (when not further harmful), and/or by service to others.   In recovery, the alcoholic needs to take a " searching and fearless moral inventory ".(19)     Kant, who said the drunkard should not be " treated as human being ", would probably admire the alcoholic who takes the fourth step. Later in the article quoted above, Kant said: " Moral self knowledge, which tries to fathom the scarcely penetrable depths of the heart, is the beginning of all human wisdom. " (20)

Much could be written (and indeed has been) regarding the effectiveness of the principles of AA.   AA is the single most important and effective entity in helping the alcoholic recover. These principles are also effective in helping people deal with a myriad of other problems. The importance of AA is such that any worker in the field is obligated to become familiar with the principles of AA.

PRACTICE IMPLICATIONS

The first priority for workers in alcoholism is to discover exactly how they view morality in the context of alcoholism. If the worker consistently feels he or she is not connecting with alcoholic clients/patients, moral issues may be at the heart of the problem. The worker may say, " but I don't ever blame the alcoholic". Then the question becomes, do you have an attitude of blame towards the alcoholic? The author has met a workers in various settings who seem quite angry at the alcoholic. These workers were unhappy and the clients did not receive the service and treatment they deserved.

It is very easy for the workers to develop an attitude of blame the longer they work with alcoholics. While work with alcoholics is extremely rewarding in that the worker can see very drastic and positive changes in clients at times, at other times the work is very frustrating.   If workers uses all of their skills and energy to help the alcoholic recover, and the client/patient does not, the tendency is to blame the alcoholic for the treatment failure. We hear " he wasn't ready " or " she couldn't get honest." The worker begins to blame the alcoholic and may start to take away consequences for the alcoholic. At this point, the worker becomes like a member of the co-alcoholic family, and effective treatment for the alcoholic is compromised.

The worker must do two things. First, the worker must examine his or her skills and knowledge base in relation to treatment failures. If a pattern emerges, then the worker needs to correct whatever deficiencies which come to light. (e.g. if a worker consistently cannot connect with court referred clients, then it would be appropriate to consult the literature or find a workshop that can help the worker better deal with that population.) Beyond that, a part of the Code of Ethics for both Social Workers and Certified Alcoholism Counselors required continued education to keep pace with the technology and developments in the work.

Second the worker must own his or her feelings of anger, powerlessness and inadequacy which are often brought up in work with alcoholics. A peer support group or an Alanon meeting for professionals are appropriate places to deal with these feelings. Stillson and Katz suggest a Supervisory Group Process Approach for dealing with countertransferential issues and burnout in alcoholism treatment.(21)   Worker support groups are necessary for the alcoholic's sake because if good workers get burnt out and leave the field of alcoholism, the alcoholic loses.

The alcoholic comes into treatment full of pain. Most treatment centers use many modalities for treating this complex disease. The ideas expressed in this article can be used in any format -lecture, individual or group. When the worker is non-judgmental, talking to the client about morality is a good point of entry to deal with the most powerful issues of addiction - denial, shame, guilt and remorse. There is no magical answer, method or framework to quickly alleviate the suffering the alcoholic experiences during active alcoholism and treatment. The alcoholic will feel the pain. With the help of the worker and an increased understanding of why what happened did, the alcoholic can effectively work through that pain and began recovery. The framework proposed can help facilitate that understanding.

The worker may need to modify these concepts based on the patient's ability and phase of treatment. It is important to always link " not morally responsible" with " always physically responsible" when using this framework; if not, the framework becomes polarized and inaccurate. The modified concepts can be directly presented to patients and families followed by the worker reaching for feedback.

The non-blaming attitude for workers which is expressed in this article in generalizable to multiple populations. With any addicted population, the specific arguments listed above apply (with some changes in the biochemistry argument). It is well known in the field of mental health that blaming the schizophrenogenic mother for her child's schizophrenia was an ineffective method for treatment family members. It is also well known that whether or not workers verbally blamed the mother, workers often had an attitude of blame - which created a personal obstacle to the helping relationship.

The reality is this: Social Workers do not see clients/patients for whom blame is an effective modifier of behavior. If blame were an effective modifier of the symptom, disease or problem, the person would no longer have the symptom, disease or problem, because if the behavior is socially unacceptable, they have been blamed many times before. This is not to say that the worker can never get angry, frustrated, disappointed or whatever with the client or patient. But it is the obligation of the worker to take care of him or herself outside of the helping relationship.

CONCLUSION

The alcoholic has long been viewed as an immoral being. That they have been so viewed is understandable when it is realized that no one understood the disease of alcoholism, and that alcoholics don't have a choice over their drinking until they receive some type of treatment and develop recovery skills. Only recently in the history of mankind has effective treatment for alcoholism existed. Attitudes held over centuries are difficult to change in decades. But when one realizes that: 1) drinking alcohol is a normal adult activity: 2) no test has been established which of us have the potential to become alcoholic; 3) when signs and symptoms of alcoholism are evident, the alcoholic no longer can control his drinking: 4) no one, if they drink enough, is able to act morally by definition because of the disinhibiting effects of the drug alcohol and (5) blaming the alcoholic in an effort to stop or cure the alcoholism doesn't and won't work (again, by definition), thus viewing the alcoholic as morally responsible for his alcoholism is both inappropriate and absurd.

On the other hand, society demands each individual to be responsible for their behavior. Even those we don't hold responsible in the usual manner (e.g. legally), we force into some type of treatment modality. The alcoholic must always be physically responsible for their behavior.

The worker has the responsibility of appropriately treatment the alcoholic and cannot do so if they overtly or covertly blame the alcoholic. Covet blame can be evidenced by having an attitude of blame, which is very easily sensed by the alcoholic because of their working with alcoholic, because of the phenomenon of co-alcoholism, to which every worker is prone.

The solution for this problem is in education and awareness for alcoholics, the workers and others. The issue is addressed presently in most treatment settings, but usually not as openly or as focused as in this article. Recovery for families and affected workers begins when they stop blaming the alcoholic, start holding the alcoholic physically responsible for their behavior and begin to own the need for their own recovery. The miracle of recovery for the alcoholic begins when he or she admits and accepts their disease. This admission and acceptance is much more likely when the shame and stigma of this disease are dealt with in an open manner. Continuing recovery depends in a large part on the resolution of guilt and shame over past behaviors. Therefore, continuing recovery depends on the alcoholic and the worker becoming attuned to the moral issues of alcoholism.

REFERENCES

1.. Several passages in the Bible address this issue: See Deuteronomy 21: 18 to 21; 1 Corinthians 5:11 13 and 6:9 11.

2. James R. Milam and Katherine Ketcham, Under The Influence: A Guide To The Myths and Realities of Alcoholism (Seattle: Madrona Publishers, 1981). , p 137.

3. Aristotle, trans. J.A.K. Thompson, The Ethics of Aristotle: The Nicomachean Ethics Translated, (London: George Allen and Univin, Ltd., 1953), pp 74 75.

4. See, for example, James P. Spradley, You Owe Yourself a Drunk, (Boston: Little, Brown and Co., 1970).

5. Herbert Fingarette, Heavy Drinking: The Myth of Alcoholism as a Disease (Berkeley: University of California Press, 1988).

6. Milam and Ketcham, p 137.

7. Henry M Tiebout, M.D., "The Direct Treatment of a Symptom", condensed from Problems of Addiction and Habituation, (Grune and Stratton, Inc., 1973).

8. John Hospers Human Conduct: Problems of Ethics (New York: Harcourt Brace Jovanovich, Inc., 1972), p 402.

9. Myra Windmiller, Nadine Lambert and Elliot Turiel, Moral Development and Socialization, (Boston: Allyn and Bacon, Inc., 1980), p. 138.

10. David F. Bush, Clark Power, Arthur I Alterman and Robert Connolly, "Moral Reasoning In Alcoholics and Addicts: Structure vs Content", Perceptual and Motor Skills, (1981) 52, pp 269 270.

11. Ibid, pp 269 270.

12. Immanuel Kant, The Metaphysical Principles of Virtue, trans. James Ellington, (Indianapolis: Bobbs-Merrill Co., 1964), p. 88.

13. J.A.K. Thomson, The Ethics of Aristotle, The Nicomachean Ethics Translated, (London: George Allen and Univin, Ltd., 1953) p. 75.

14. Ibid

15. Father Martin "Chalk Talk"

16. Hospers, p. 399.

17. Ibid, p. 404.

18. Alcoholics Anonymous, Alcoholics Anonymous, Third Edition (New York: Alcoholics Anonymous World Services, Inc., 1976), p. 58.

19. Ibid, p. 59.

20. Kant, p. 104.

21. Kathy Stillson and Carole Katz, "A Supervisory Group Process Approach to Address Staff Burnout and Countertransference in Alcoholism Treatment", Psychosocial Issues in the Treatment of Alcoholism, (New York: The Hawthorne Press, Inc., 1985), pp 117 134.

Comments about this article are welcome.  Please address to:  stofle@aol.com

Reference:
Stofle, G.S. (1999). The Morality of Alcoholism. [Online]. Perspectives. [1999, April 13].




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