In view of what has been said it is clear, I think, that the real causative factors are those which induce a nervous condition first, and that this condition in turn induces alcoholism. In other words, alcoholism does not directly result from an event or a series of events in the manner that fever results from am infection.

Drinking, or an isolated debauch, may follow a specific stimulation, but chronic alcoholism is a pathological method of life and not a mode of revenge, diversion, or even of suicide. The majority of men -- and this must necessarily include a goodly number who are none too brave -- simply do not choose that means of faring their troubles or of ending their life.

Says Dr. Myerson in his Foundations of Personality "Not all persons have a liability to the alcoholic habit. For most people, lack of real desire or pleasure prevented alcoholism. The majority of those who drank little or not at all were not in the least tempted by the drug. 'Will power' rarely had anything to do with their abstinence, and the complacency with which they held themselves up as an example to the drunken had all the flavor of Pharisecism.

To some the taste is not pleasing, to others the immediate effects are so terrifying as automatically to shut off excess. Many people become dizzy or nauseated almost at once and even lose the power of locomotion or speech."

Anything that creates fear in a person creates uncertainty, timidity, inferiority; and so I firmly believe that the inferiority complex of the Adlerian School of abnormal psychology goes much further in explaining the origin of alcoholism than the pansexualism of Freud.

I agree with Dr. Schmalhausen when he says: "The ego is more pervasive as a human reality than sex. Human natures that harmonize on the ego level can contrive to put up with sex disharmony; but sex harmony cannot cope with the problem of disharmony rooted in a maladjustment of egos. The Adlerian theme runs deeper in human life than the Freudian, though the latter, because of its dramatic and sensational components, gives the impression of being more fundamental."

Inasmuch as Dr. Schmalhausen's book, Why We Misbehave, is very far from being hostile to much that has been written by Freud, this remark is quite significant.

At any rate I have yet to find a case of alcoholism which seemed to rest on suppressed sexual desires either normal or abnormal, unless all uncalled-for violence is to be interpreted as Sadism and all exaggerated friendliness is reduced to terms of homosexuality which does not seem reasonable to me.

Nor does this opinion arise from any prejudice against Freud in favor of Adler or from any a priori reasoning. As a matter of fact, it came somewhat as a surprise in my experience that alcoholics should be so free from sexual disturbances past and present.

As I do not explore the unconscious by psychoanalysis or hypnotism, I cannot make an unqualified statement that there is not a deep-seated relationship that can be discovered by these methods. It has, however, seemed unnecessary to go to such lengths to procure satisfactory results.

On the other hand, sex can function as a conscious or semiconscious stimulation to drink under certain conditions as contrasted with a fundamental instinctive urge. Men who are self-conscious in the presence of women find it easier to accomplish their purpose if their timidity is removed by alcohol (though "satyrs" never allow any blunting of their sensibilities to interfere with their pleasure).

Furthermore, many men have more of a conscience than they realize. Alcohol will suppress this inhibiting force during the event and give them an excuse ("I wouldn't have done it if I hadn't been drunk") to dispel remorse after it is over. Thirdly, the crudities, of coarse, inferior women are obliterated if men of sensibility drink a sufficient amount. Thus for many a bachelor, unable to find a woman of his own class, the old association of "wine, women, and song" consciously or unconsciously recommends itself.

For the man who is going to stop drinking this association must be broken up. There is no biological urge for drink such as there is for sex, and only vicious custom has given them a connection. If this break cannot be made, then "women" must be avoided until the alcoholic habit has been definitely overcome. An inebriate's entire life depends on the successful outcome of the treatment; so it will not do him any harm if he finds he has to do without women until this has taken place.

In contrast to the sexual theme, them always appears inferiority in some form or another, often to a marked degree and most cases fully admitted, although sometimes a compensatory mechanism is at work. (disguised under a bold front.

Alcohol, with the "Dutch courage" that it temporarily supplies, is a logical antidote for inferiority. Some of the causes of this inferiority, in addition to the early environment already referred to. are shocks, humiliations, accidents, failures in athletics and scholarships as well as in business, disappointments in love, inability to make friends, and the doing of some act which, even if unknown to the outside world, degrades the individual in his own eyes.

According to Dr. Myerson, " 'Dutch courage' drove from many a man the inferiority and fear that plagued his soul. True, it drove him into a worse situation, but for a few moments he tasted something of the life that heroes and the great have. If we can ever find something that does not degrade as it exalts, all the world will rush to use it." [The italics are mine.]

A case might be mentioned of a man becoming a drunkard as a result, so he thought, of having his Heart broken in a love affair. This individual had always been lacking in self-confidence, but his girl had temporarily given him the feeling of power that he had abnormally craved.

When she terminated their relationship he collapsed. A short analysis soon showed him that it was his ego that was broken and not his heart. Sad he was, without question, but it was humiliation and not sorrow that "drove" him to excessive, drinking.

Just as we speak of a vicious circle of cause and effect which moves faster and faster as drinking continues, so we can with equal validity refer, in the case of inebriates, to the cessation of drinking as a benign circle where confidence and poise follow sobriety, inferiority disappears, and so sobriety itself is made easier. Self-respect is substituted for degradation.

While the eliminating of drink itself has been the factor in determining this restored state of mind, still there may be other forces at work which will determine whether or not the alcoholic is going to be able to complete satisfactorily his treatment.

If he is leading, apart from his drinking, a life which causes him to lose caste in his own eyes, it is almost certain that he will conceive of himself as too weak or vicious to give up the drink habit, though this low opinion of himself may be partly repressed into the unconscious.

The most ready illustrations of the above condition are the sexual irregularities on the part of married men. Many men, as has been mentioned before, have more of a sex conscience than they realize.

Some, of course, though they would collapse under the remorse following a petty theft and are in many other directions anything but conscienceless, have no immorality conscience at all.

On the other hand, there are a great many men who pretend to this irresponsibility, whereas in reality they are unable to escape the traditions of their inheritance and bringing up. I have had two cases which have involved extramarital sexual relationships. In each case I replied that, as long as it did not lead to drinking directly through emotional contagion or indirectly through a feeling of guilt which produced inferiority, it was their own problem to decide.

However, these men voluntarily came to the conclusion that, inasmuch as their wives were doing all that they could to make the home a happy one, they would make a clean sweep of their entire irregular life. They found that fundamentally they did feel conscience stricken, and that in addition the fear of being caught had a demoralizing effect upon them.

I have known of other men in this predicament who, because of the difference of their natures, did not require the adjustment of this factor in their treatment and cure.

But sex is by no means the only cause for an enervating and demoralized self-ideal, nor is it necessarily the most important one. It was merely used as a convenient illustration. Any form of behavior which lowers a man in his own eyes, whether the outside world knows about it or not, will obviously prevent the vigorous, sustained, and un-diverted concentration on the giving up of the alcoholic habit.

Lying furnishes another excellent illustration of destructive conduct. A man who lies to those who have a right by nature of their position to know of his affairs is soon motivated by the feeling that if he is not man enough to tell the truth to those who are endeavoring to help him, he is not man enough to give up drinking. While he may not consciously formulate this relationship in so many words, the effects- that is, his actions -- soon testify to its validity.

A man quite naturally has feelings of inferiority at the beginning of his treatment because of the effect that alcohol has had upon him. and so he should do all in his power to eliminate anything that fosters a lack of self respect, whether it appears on the surface to pertain directly to the question of drinking or not.

"If," writes Professor McDougall in his Outline of Abnormal Psychology, "a unitary personality is to be achieved, the various sentiments must be brought into one system within which their impulses must be harmonized, each duly subordinate to the higher integration of which it becomes a member.

"This higher integration is what we call 'character'; it is achieved by the development of a master sentiment which dominates the whole system of sentiments, subordinating their impulses to its own . . . . The only sentiment which can adequately fulfill the function of dominating and harmonizing all other sentiments is the sentiment of self-regard, taking the form of a self-conscious devotion to an ideal of character. . . .

"A firm or strong or well-knit character, one that can resist all disintegrating influences, is one that can face all problems, all critical alternatives, and can make a decision, can choose one of the alternatives and give that line of action an assured predominance over all others; and this capacity depends upon the organization of the sentiments in an ordered system dominated by a master sentiment; and of all possible master sentiments the most effective is a sentiment for an ideal of character, an autonomous self, a reflective self that can control, in the light of reason and moral principles, all the promptings of other sentiments as well as the crude urgings of instinct and appetite."

Another factor in the background of alcoholism, which is common to all neurotics, but which might escape those uninitiated to abnormal psychology, is the fact that by his conduct the alcoholic is making himself important in his own eves.

Prevented by his habit from living a constructive life, he is unconsciously anxious to make a stir in the world, even though this stir is of a purely destructive nature. Anything is better than oblivion, and so all the fuss that is made about him, as well as the fact that he is a "serious problem," is not as distasteful to him as he may imagine.

In fact, he often considers himself a heroic villain or martyr. Those who have had dealings with drunkards have noticed the phase of self-pity wherein they expatiate at length about the curse that is laid upon them. They delight in relating how they are drinking themselves to death; it seems that they cannot help this unfortunate procedure, since, owing to inheritance or some other bugaboo, they are in the clutches of a " vice" which is more powerful than they are.

Often this discourse is accompanied by drunken temperance lectures. In a weepy manner they implore their audience not to follow in their footsteps, and state with great emphasis that, had they their lives to lead over again, they would never touch a drop.

This is, of course, 100 per cent hocus-pocus, and nobody realizes it more than the man who has given up the habit "he couldn't help" and has learned to satisfy his craving for attention in a legitimate manner.