Sobering thoughts
Colin Brewer
Acohol, as Jeffrey Bernard and Auberon Waugh enjoy telling us, is a wonderful invention and many citizens, in- cluding me, get a lot of innocent if expen- sive pleasure from the taste and the effect of the stuff. Unfortunately, as everyone knows, a common undesirable effect .of alcohol is that it makes people do anti- social and illegal things which they wouldn't otherwise have done. Quite often, the result is a prison sentence — sometimes a long one.
Alcoholism among prisoners is common and many crimes are committed because of excessive drinking. Sometimes these are `one-off offences by people who don't nor- mally drink much, but many offenders have a history of consistent heavy drinking and there will often be a record of previous alcohol-related offences, injuries or ill- nesses. Depressingly often, these offenders will drink heavily again as soon as they leave prison and will thus commit further offences, sometimes on the very day they are released. Most offences will be against property or public order, but a high propor- tion of violent offences are due to drink. If such people could be stopped from drinking, many would not commit further offences (or at least they would commit fewer and less serious ones) and it would not be necessary to keep them in prison for so long or at all. The conventional wisdom is that most alcoholic offenders cannot be made to stop drinking out of prison. The conventional wisdom is wrong.
It is actually quite easy to stop alcoholics — criminal or otherwise — from drinking. You simply give them adequate doses of a curiously unfashionable drug called Anta- buse (or the similar drug Abstem), which has been around since the late Forties, and which has the effect of producing a very unpleasant reaction within a few minutes of any significant quantity of alcohol being consumed. The more you drink, the worse the reaction becomes. Few people experien- cing an alcohol-Antabuse reaction will be in a position to do anything more anti-social than lie down and be sick. An obvious snag with Antabuse is that, like any other drug, it only works if it is taken. Since the chief characteristic of most alcoholics is that they rather like drinking, most of those who are given a bottle of Antabuse, and told to keep on taking the tablets, stop tak- ing them, usually within days or weeks.
However, we have ways of making sure that people take medication when it is really necessary. For patients incapacitated by age or illness, doctors commonly ask someone reliable to supervise administration. Where the patient is reluctant rather than in- capable, the supervisor must obviously have some moral or legal authority. Family members or colleagues, with medical sup- port, can often supply the former: courts and probation officers can certainly supply the latter. Antabuse can be taken under supervision as a condition of probation. It is a long-acting drug — up to a week — so that failure to attend (thrice weekly is ade- quate), as well as being a breach of proba- tion, acts as a trip-wire giving police or pro- bation officers a chance to intervene before drinking, and offending, can start again. Naturally, Antabuse is taken in liquid form to ensure 'compliance', as we call it in the trade.
It is sometimes objected, particularly by those of the psychoanalytic persuasion, that this treatment does nothing for the `psychological problems' which are alleged to lie behind alcoholism. This is undoubted- ly true, but it is a good deal easier to deal with these problems if the patient remains sober — and a considerable proportion of alcoholics seem to have no significant underlying problems once they stop drink- ing. Their problem is that they drink too much.
It is clear that a useful number of alcoholic offenders can be kept sober for long periods if, instead of going to prison, they take Antabuse as a condition of proba- tion under the direct supervision of the pro- bation service. The offender is not forced to take Antabuse, but he is offered it as an alternative to the prison sentence which he would otherwise have received, on the understanding that failure to take Antabuse as agreed constitutes a breach of probation for which he can be returned to the court and, where appropriate, to prison. Not sur- prisingly, most people offered a choice bet- ween incarceration and conditional liberty chose liberty.
This approach was tried out in the US during the Sixties with very encouraging results And has been used here in a few cases with equal success. The treatment is very simple, and economical of time and money. The American study, by Dr Peter Bourne and colleagues from the University of Atlanta, showed not only that nearly two- thirds of the offenders took Antabuse regularly while they were on probation but — most encouragingly — that many wished to continue with Antabuse even when pro- bation had ended. 'Perhaps most spec- tacular in this group,' they write, 'were several patients who had served as much as ten years in jail for drunkenness in con- secutive 30-day sentences but who, after starting on Antabuse, had remained absti- nent for several months and had been able to hold steady jobs during this time.' This was a relatively short-term study. Other clinical trials of supervised Antabuse have shown that sobriety can be maintained for years rather than months. As drugs go, An- tabuse is low on side effects. It is certainly much less toxic than alcohol.
There are so many alcoholic prisoners that if only a quarter of them could be enabled — or persuaded — to remain sober, there would be a significant impact on the prison population. This can be done — or at least attempted — using existing legislation and facilities. Given simple addi- tional legislation, Antabuse could also be used as a condition of parole, or in con- junction with weekend imprisonment. In this way, prison might be truly reformative or even therapeutic for a large and impor- tant group of offenders.
The unpopularity of Antabuse is one of the mysteries of medicine and alcoholism• Alcoholics Anonymous is generally opPns- ed to it, and I know of patients in alcoholic hostels who have been bullied into stopping it by the social workers who run such establishments, always with disastrous results. Drinking on top of Antabuse can be dangerous as well as unpleasant, but serious consequences are very rare, especially com- pared with the dreadful mortality from un- checked alcoholism. I suspect its un- popularity has something to do with the `wetness' which has affected psychiatry as well as other institutions. (In the case of social work, wetness is almost a defining characteristic.) Perhaps in a more arid climate, supervised Antabuse will not seem such a novel and outrageous idea.
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