WHO ARE THE INEBRIATES?

Among the world-wide authorities on the subject of inebriety perhaps no one holds a higher rank than Dr. R. W. Branthwaite, Inspector of Retreats and Reformatories under the English Inebriates Acts. Added to his thorough equipment as a scientist he has the great advantage of a long experience of dealing with inebriates and unusual opportunities for observing them. Therefore he has gained a wide hearing among European scientists. Of especial interest are his views of the extent of inebriety among the populations of England and Wales. But of greater significance, because more fundamental, are the conclusions he has arrived at in regard to the nature of the malady we know as inebriety. The standpoint Dr. Branthwaite takes on both these matters does not accord with popular notions, but has the merit of being scientifically correct. Its more general acceptance would help us to straighter thinking and saner action in dealing with questions arising out of the liquor problem.

The following extracts from Dr. Branthwaite's official report for the year 1912 (published by the British government in 1914) restates his conclusions concerning the extent and nature of inebriety:

"Viewed from an alcohol-drinking standpoint, all members of the community may be divided into those who take alcohol and those who do not. Alcohol-takers may again be subdivided into: (1) Moderate drinkers-persons who are always strictly moderate in their indulgence;

(2) Occasional drunkards-persons who drink more freely than is consistent with strict moderation, and are occasionally drunken; and

(3) Inebriates-persons who are habitually under the influence of drink, or, with intervals of abstinence, are subject to outbursts of uncontrollable drunkenness of more or less defined duration.

"Moderate drinkers.-So far as members of the first section are concerned, there is little to be said; the harm they do to themselves is problematical, and the harm they do to others still more so. The large majority take alcohol because it is customary, as an

aid to social intercourse, to give relish to food, or for the bodily sense of well-being it engenders when swallowed in small quantities. This bodily sense of well-being is the only pharmaco-dynamic effect they desire to experience, and any sensation of more advanced alcoholization is repugnant to them. There is no credit due to such persons for being sober, because they have no desire to be otherwise, and it is no trouble for them to keep sober, because they are not called upon to exercise control over desires that do not exist.

"The occasional drunkard.—So far also as this type of man is concerned, merely passing attention will suffice; then we may similarly dismiss him from further notice. The essential difference between the occasional drunkard and the inebriate is the fact that the former retains the power to remain sober if he cares to exercise it. Deficient perhaps to some extent in moral sense, power of control over impulses, and power of judgment, he still remains on the right side of the line, and may therefore be eliminated from consideration for present purposes. He is a person who requires education into sobriety by moral means; if these fail and he becomes a nuisance to the community, causes disorder or commits crime when under the influence of drink, he needs coercion more penal than reformatory to bring him to his senses. We may safely leave him to the temperance worker, or the magistrate. It is possible, of course, that degenerative change consequent upon many bank-holiday sprees, convivial meetings, or banquets, may eventually turn him into an inebriate; but until such change occurs he remains outside the class in which we are specially interested.

"The inebriate. So far, however, as the inebriate (habitual drunkard, chronic alcoholic, or dipsomaniac) is concerned, the matter is entirely different. Although there may be difficulties at arriving at a legal definition of the species, the medical point of view is clear enough. An inebriate is a man who may or may not desire to live soberly, but in any case cannot, unless and until some change takes place in his physical and mental state. The more we see of habitual drunkards, the more we are convinced that the real condition to be studied, the trouble we have to fight, and the source of all the mischief, is a psycho-neurotic peculiarity of some sort; an inherent defect in mechanism, generally congenital, sometimes (more or less) acquired. Alcohol, far from being the chief cause of inebriety, is merely the medium that brings into prominence cer

tain defects that might have remained hidden but for its exposing or developing influence.

"The inebriate, then, is the subject of a peculiarity, the distinctive characteristic of which is inability to take alcohol in moderation, despite the most strenuous effort of which he is capable. It is often possible for him to abstain from alcohol altogether; but rarely (if ever) possible for him to take it without becoming drunken. He is the victim of a psycho-neurotic fault that implies a defective power of resistance to the action of alcohol or drugs, in exactly the same sense as tubercular tendency implies impaired resistance to the specific infection of that disease. The peculiarity or fault is an extremely potent one, calling for recognition as the true inebriate state of which drunkenness, disorder, and erratic behavior generally are merely outward and visible signs.

"Although it is clear that a marked correlation exists between the recognized forms of mental defect or disease, on the one hand, and habitual drunkenness on the other, the association is not definite enough to justify the commonly heard statement that all inebriates are more or less insane or mentally defective. When inebriates of all social grades are classed together it will be found that the majority are neither the one nor the other; indeed, many typical inebriates are extremely capable individuals during sober intervals. Notwithstanding this, even the most mentally sound amongst them are not normal persons; the evidences of peculiarity are too definite to be ignored, although its character is difficult to define, and its location obscure.

"If this be so, it follows that the inebriate is not primarily vicious or criminal, but primarily abnormal, and only secondarily anti-social. Most of the offences he commits are of passive nature, due rather to impaired reason that to wilful intention, or to imperfect control-the result of a drunkenness he is partially, or perhaps wholly, unable to avoid.

"It is held that a drunken person should be accorded full measure of responsibility for the perpetration of offences against the law, in that his condition results from a wilful act-the taking of liquor. Of the occasional drunkard this is probably true; but not of the inebriate. The latter is impelled to his first glass by irresistible desire, and his constitutional peculiarity does the rest. The desire is abnormal, and so is the constitutional condition that renders him. incapable of being satisfied with one glass, as would be the case with

a normal person. Between the responsibility of the occasional drunkard and the irresponsibility of the inebriate there are many grades of quasi-responsibility, the extent of which there is no means of estimating; such fine distinctions must be left for further experience to determine. In the meantime, considerable advance will be made if the irresponsibility for habits, and for offences the results of such habits, is more widely accepted and acted upon, in the case of persons who are definitely inebriate.

"If irresponsibility be acknowledged, or even quasi-responsibility, the argument in favor of treatment as opposed to punishment must be recognized also. It is as illogical to punish an inebriate for an offence due to drunkenness, the while ignoring the motive force that determines the offence, as it would be to attempt the treatment of a disease without previously removing an obvious cause.

THE PREVALENCE OF INEBRIETY

"All that is known with any approach to certainty regarding private 'non-criminal' inebriates is that somewhere about 4,000 persons, resident in England and Wales, have submitted themselves to treatment in licensed and unlicensed homes, or have endeavored to find relief by resort to some of the best-known cures during the last three years. Knowing the vast number of persons who make enquiry regarding the conditions that govern admissions to institutions, and go no further with the matter for financial or other reasons, it is unlikely that this figure represents more than a quarter of those who are qualified for treatment. Most of the managers of Retreats, and homes for inebriates of all kinds, maintain that not more than 1 out of every 10 or 12 persons who apply for particulars is subsequently admitted. Accepting the first suggestion as more probably correct, and as more likely to understate than overstate the case, a round figure of about 16,000 is obtained, which is as close an estimate as circumstances permit.

"Turning now to the lower class inebriates, those who commit offences as the result of their habits, and are constantly in and out. of prison in consequence, the facilities for estimate are not much. greater.

"The Metropolitan Police Authority is the only one in the kingdom that makes any effort to separate inebriates from occasional drunkards, and this is only attempted (at present) in the case of women. During the three years ended December 31st, 1912, about

2,500 names of such women were recorded. It is therefore known that at least this number of women inebriates qualified for committal to Reformatories are in the Metropolitan Police District. How the number of male persons of similar type would compare with this it is difficult to say; it would probably be much smaller, as the drunken recidivist man is not so common as the recidivist woman. It is true that the number of men convicted at police courts usually equals and often exceeds the number of women; but, the fact that occasional drunkenness is more common in men than in women must be taken into full consideration.

"If to the 2,500 known women inebriates a further 1,500 men be added, an approximate 4,000 of both sexes is obtained, as the figure probably representing the number of London inebriates of the recidivist police court type. This number is equal to about 1 in 1,130 of the total population of the County of London and would seem to indicate the probability that about 32,000 of the same class can be found in England and Wales.

"This seems to indicate roughly that there are about 48,000 inebriates, of all classes, in England and Wales at the present time (about 1.42 per 1,000 of the population), of which number about 16,000 are persons in private life-whose habits have not led to conviction in police courts-and 32,000 known to have criminal or disorderly tendency. Dealing in round figures this means, in relation to total population, approximately 5 per 1,000 of the former and I per 1,000 of the latter."