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ALCOHOLISM IN INDUSTRY AND FAMILY
1179
by phosphofructokinase; but it seems that fructose-1phosphate, produced by the action of fructokinase, can bypass this second phosphorylation and break down directly into the immediate precursors for glycerol phosphate. The breakdown is accomplished by a special enzyme, an aldolase specific for fructose-1-phosphate, and its activity in human liver is 2-08 units per g. This value is similar to the more common aldolase on the glycolytic pathway. Thus, fructose is converted into glycerol phosphate quicker than is glucose, and the enzymes required for the conversion of fructose are present in human liver and avoid the two slow reactions in the breakdown of glucose (catalysed by hexokinase and phosphofructokinase respectively). Evidence is now at hand therefore to explain the observations that fructose rather than glucose favours the formation of glycerides.
ALCOHOLISM IN INDUSTRY AND FAMILY
RECENT weeks have seen much discussion in this country concerning alcoholism and its treatment. Television and the Press have been active; and the National Council on Alcoholism held its annual conference in London on Nov. 14 to discuss alcoholism in industry and family. The Press and the B.B.C. also gave much attention to a publication, Alcoholism in Industry, from National Lifeline-a consortium consisting of the Helping Hand Organisation, the Apex Trust, and the Circle Trust. At the conference Mr. Archer Tongue, director of the International Council on Alcoholism, said that in many countries it was widely recognised that there was a large problem, but everywhere, as in Britain, it proved difficult to convince industry itself that only the tip of the iceberg had been demonstrated. Prof. Leonard Goldberg of the Karolinska Institute, Stockholm, was able to produce cold hard facts correlating the accident-rate in industry, on the roads, and at home with the availability of alcohol and pointing to a direct link between absenteeism and differences in the use of problem drinking. Semantic " " " problem drinker " and alcoholic existed between Great Britain and Sweden, though it was clear that Goldberg’s problem drinkers really fell within the W.H.O. definition of the alcoholic, but perhaps represented a diagnosis more readily accepted by industry. Sir Alistair
Murray, chairman of the Glasgow Council Alcoholism, and Mr. John Gray, director of the Council, described the first field study of alcoholism in
on
industry
achieved in Great Britain. This work was of a research programme on the incidence of the disease at various levels. Unfortunately, as the industry concerned preferred for the present to remain anonymous, the findings lost some of their impact. One startling fact emerged: at the top level in the industry, the " managers " expected an incidence of about 4%, the experimenters estimated 8%, but the actual incidence was found to be 14%. Such a figure hints that something in the nature of the industry itself had an attraction for the practising alcoholic. In this country the Institute of Directors has more than once denied the existence of a serious alcohol problem in industry. The Glasgow figures must make the Institute and its medical advisers think
the
start
ever
For one thing, what alcoholic patient would his illness to industry’s medical representatives ? report The Trades Union Congress recognises there may be a problem, but it feels that many other matters have greater priority. Yet the visible annual loss to industry has been put at at least E24 million and the hidden damage at a further E75 million.
again.
Dr. Beresford Davies,
discussing the " ecology of a family problem ", gave striking figures of the incidence of abnormal personalities in the spouses of alcoholics. Though his sample was small and the statistical significance was not enlarged upon, he showed that the usual image of the wife of the alcoholic as a clinging woman of masochistic nature was perhaps inaccurate, since a very high proportion of the patients he studied " escaped " from the domestic scene. Male some
spouses of alcoholics
seemed, on the contrary, to be more Dr. Beresford Davies’s thesis was later challenged caring. as far from the usual clinical experience of those treating the disease; regional differences were, of course,
possible. The Cardiff approach (Adfer) to treatment was well demonstrated by Dr. Myrddin Evans who, with his large group of social workers, must have been the envy of many psychiatrists who have to manage with one or perhaps even none. The great care and support offered to the alcoholic and his family were clearly shown; and the ready and complete involvement with local authority services was underlined. The methods of the Croydon psychiatric service approach were illustrated by Dr. Clifford Salter, chairman of the N.C.A. medical committee, and members of the staff He team from Pinel House alcoholic addiction unit. that of the unit’s part philosophy in emphasised the illness as a recognising family problem was to accept that it was usually necessary to give the husband and wife, and indeed any other closely involved relative, some time to be apart, to gain in objectivity and in insight into their related problems. He doubted the ultimate value of the Adfer approach: too much material support had proved (as the unit at Warlingham had early discovered) a hindrance in increasing the alcoholic’s motivation to give up drinking for the rest of his life. The alcoholic’s worst enemy was his own ability to manipulate situations in order to maintain sources of supply. The aim in treatment both of the alcoholic and of the relative was to enable personality development of the individuals to progress to the point of interdependence, rather than dependence; to emphasise the strengths rather than the weaknesses in character formation. For many, Pinel House was the first real experience of " home " as a place where psychological needs could be and were met. Often the spouse developed the same feelings, since his or her emotional needs had been as deprived, or even more so, as those of the patient. For both alcoholic and spouse, open-ended therapeutic groups were
provided after inpatient
treatment
pleted, and any member of the team available.
was
was
com-
always readily
The conference promised better success in terms of and stimulating interest in areas to which the seriousness of the problem has not penetrated. Many more leaders from industry were present than attended last year’s N.C.A. conference, and it is to be hoped they will act as a catalyst to further research programmes, such as the Glasgow experiment.
informing
by phosphofructokinase; but it seems that fructose-1phosphate, produced by the action of fructokinase, can bypass this second phosphorylation and break down directly into the immediate precursors for glycerol phosphate. The breakdown is accomplished by a special enzyme, an aldolase specific for fructose-1-phosphate, and its activity in human liver is 2-08 units per g. This value is similar to the more common aldolase on the glycolytic pathway. Thus, fructose is converted into glycerol phosphate quicker than is glucose, and the enzymes required for the conversion of fructose are present in human liver and avoid the two slow reactions in the breakdown of glucose (catalysed by hexokinase and phosphofructokinase respectively). Evidence is now at hand therefore to explain the observations that fructose rather than glucose favours the formation of glycerides.
ALCOHOLISM IN INDUSTRY AND FAMILY
RECENT weeks have seen much discussion in this country concerning alcoholism and its treatment. Television and the Press have been active; and the National Council on Alcoholism held its annual conference in London on Nov. 14 to discuss alcoholism in industry and family. The Press and the B.B.C. also gave much attention to a publication, Alcoholism in Industry, from National Lifeline-a consortium consisting of the Helping Hand Organisation, the Apex Trust, and the Circle Trust. At the conference Mr. Archer Tongue, director of the International Council on Alcoholism, said that in many countries it was widely recognised that there was a large problem, but everywhere, as in Britain, it proved difficult to convince industry itself that only the tip of the iceberg had been demonstrated. Prof. Leonard Goldberg of the Karolinska Institute, Stockholm, was able to produce cold hard facts correlating the accident-rate in industry, on the roads, and at home with the availability of alcohol and pointing to a direct link between absenteeism and differences in the use of problem drinking. Semantic " " " problem drinker " and alcoholic existed between Great Britain and Sweden, though it was clear that Goldberg’s problem drinkers really fell within the W.H.O. definition of the alcoholic, but perhaps represented a diagnosis more readily accepted by industry. Sir Alistair
Murray, chairman of the Glasgow Council Alcoholism, and Mr. John Gray, director of the Council, described the first field study of alcoholism in
on
industry
achieved in Great Britain. This work was of a research programme on the incidence of the disease at various levels. Unfortunately, as the industry concerned preferred for the present to remain anonymous, the findings lost some of their impact. One startling fact emerged: at the top level in the industry, the " managers " expected an incidence of about 4%, the experimenters estimated 8%, but the actual incidence was found to be 14%. Such a figure hints that something in the nature of the industry itself had an attraction for the practising alcoholic. In this country the Institute of Directors has more than once denied the existence of a serious alcohol problem in industry. The Glasgow figures must make the Institute and its medical advisers think
the
start
ever
For one thing, what alcoholic patient would his illness to industry’s medical representatives ? report The Trades Union Congress recognises there may be a problem, but it feels that many other matters have greater priority. Yet the visible annual loss to industry has been put at at least E24 million and the hidden damage at a further E75 million.
again.
Dr. Beresford Davies,
discussing the " ecology of a family problem ", gave striking figures of the incidence of abnormal personalities in the spouses of alcoholics. Though his sample was small and the statistical significance was not enlarged upon, he showed that the usual image of the wife of the alcoholic as a clinging woman of masochistic nature was perhaps inaccurate, since a very high proportion of the patients he studied " escaped " from the domestic scene. Male some
spouses of alcoholics
seemed, on the contrary, to be more Dr. Beresford Davies’s thesis was later challenged caring. as far from the usual clinical experience of those treating the disease; regional differences were, of course,
possible. The Cardiff approach (Adfer) to treatment was well demonstrated by Dr. Myrddin Evans who, with his large group of social workers, must have been the envy of many psychiatrists who have to manage with one or perhaps even none. The great care and support offered to the alcoholic and his family were clearly shown; and the ready and complete involvement with local authority services was underlined. The methods of the Croydon psychiatric service approach were illustrated by Dr. Clifford Salter, chairman of the N.C.A. medical committee, and members of the staff He team from Pinel House alcoholic addiction unit. that of the unit’s part philosophy in emphasised the illness as a recognising family problem was to accept that it was usually necessary to give the husband and wife, and indeed any other closely involved relative, some time to be apart, to gain in objectivity and in insight into their related problems. He doubted the ultimate value of the Adfer approach: too much material support had proved (as the unit at Warlingham had early discovered) a hindrance in increasing the alcoholic’s motivation to give up drinking for the rest of his life. The alcoholic’s worst enemy was his own ability to manipulate situations in order to maintain sources of supply. The aim in treatment both of the alcoholic and of the relative was to enable personality development of the individuals to progress to the point of interdependence, rather than dependence; to emphasise the strengths rather than the weaknesses in character formation. For many, Pinel House was the first real experience of " home " as a place where psychological needs could be and were met. Often the spouse developed the same feelings, since his or her emotional needs had been as deprived, or even more so, as those of the patient. For both alcoholic and spouse, open-ended therapeutic groups were
provided after inpatient
treatment
pleted, and any member of the team available.
was
was
com-
always readily
The conference promised better success in terms of and stimulating interest in areas to which the seriousness of the problem has not penetrated. Many more leaders from industry were present than attended last year’s N.C.A. conference, and it is to be hoped they will act as a catalyst to further research programmes, such as the Glasgow experiment.
informing