The first essential requirement for successful treatment is the sincere desire to be helped on the part of the alcoholic himself.

Nothing constructive has ever been accomplished or ever will be with men who are dragged or pushed toward curative measures by friends or relatives.

In fact, sometimes actual harm is done by such a procedure. A man will often reject premature persuasion, and, once having rejected it, may maintain his attitude for all time.

He should be informed that professional assistance is available and then left undisturbed to seek it on his own initiative.

I can well understand from the point of view of the family that "premature" may hardly seem a suitable word to apply to a person who has been drinking to excess for many months and possibly years, but in spite of this fact, I repeat, he should be given the idea as a suggestion and then left alone to think it over.

Nothing may ever come of it, to be sure, but on the other hand he may be much more concerned with the matter than appears on the surface. No action may result until some particularly depressing Series of events has brought vividly home to him the futility of trying to continue drinking and the apparent impossibility of giving it up unaided.

If he should have a friend who has been successfully treated and in whom he has confidence some pressure may be applied by this friend, but even here tact and suggestion should be relied on more than persuasion or exhortation.

Alcoholics are apt to be extremely stubborn people; in fact, it might be said with much truth that the therapeutic problem consists in redirecting this stubbornness from destructive to constructive ends.

One man, who now no longer drinks anything, when first informed by an ex-alcoholic that there was a systematic method for treating inebriety, did nothing about it for a year, although it had long been obvious to even his most dissipated friends that he simply could not withstand alcohol.

Matters naturally went from bad to worse, but this seemed to be necessary in order to convince him that his habit had definitely gotten the upper hand. When at last he awoke to his condition, he allowed his friend to bring him in for an interview.

Before very long he was a successful case himself, though both he and the friend who introduced him had looked upon the situation as hopeless before the treatment.

However, he did want to stop, or, to use his own phraseology, he "wanted to want to stop," which is all that can be desired in the uninitiated.

The surrender to the fact that alcohol can no longer be indulged in without bringing disastrous results is of such importance that it requires extremely thoughtful consideration. This surrender is an absolute starting point as far as the conscious mind is concerned.

Experience has shown, however, that an intellectual surrender by no means settles the question, because there are unconscious motivations working in opposition which the patient must be made aware of and upon which he must devote considerable reflection in order that a distorted pride may be expelled from the deepest recesses of the mind.

The alcoholic, in company with all other drinkers, started his habit with the idea of being smart or manly as one of the main impulses. Although this idea is supposed to pass away with the coming of maturity, in reality it does not do so.

It still lingers in the unconscious as a sort of credo and accounts for much of the driving force which operates against a graceful surrender to the inevitable. In some cases it is fully conscious, and the individual frankly admits that he hates to say "no forever" for reasons which are hard for him to explain because they seem to be apart from an actual desire to drink.

When he is confronted with the "manly" or "freshman" complex, as I often call it, a certain illumination is shed on the question, though often it takes a little analysis and "explanation for the idea to become a conviction.

If he will face this problem and bring to bear on it the counter idea (which is, of course, only too obvious) that it is the manly thing to give up drinking because weaklings cannot do it, he will accomplish a great deal in the correcting of a very deep-seated obstruction to the cure.

It is driving home platitudes as if they were profundities over and over again that actually unifies the emotional system with the intellect so that the latter has complete and permanent domination.

Another reason for not wanting to surrender is that the patient visualizes such a step in the light of an irrevocable pledge which he might some day want to retract. The sooner he takes this "pledge" by himself, the better off he will be, but he is not asked to do so, and a little reflection should show him that as long as he remains in a civilized community there is nothing to prevent a retraction if he really wants to make it.

A third way of expressing this will-not-to-surrender is in terms of bogus freedom. The alcoholic wishes to feel "free" to do as he likes; he does not want to bow to the will of his family, his friends, the prohibitionists, or his own better self.

This demand for free self-expression may be logical for the man who has drink under control. He may be justified in resenting the interference of those who wish by legislation to interfere with customs which are as old as civilization.

But the drunkard should realize that he is in search of a larger freedom which rises far above the influence of man-made law. He has become a slave to something which can in the long run only be used by those who remain masters of it.

In reality he has not known what freedom was since the first trial to limit his drinking and found himself unable to do so. The only freedom he can enjoy is that derived from an abstinence which gives him assurance and self-respect in his own eyes.

When he knows each day what he has done, what he wants to do, and when he feels within himself the power to do it, then and then only can he understand the true meaning of the word "freedom," as well as the absolute bondage that he was in when he tried to express himself "freely" by drinking all the alcohol that he could lay his hands on.

These various theories for not surrendering are often supported by actions clearly showing unconscious motivation: such, for instance, as persistent attendance at very wet parties (though the patient was "absolutely sure of Himself" before he went to them), quarrels with relatives and friends inducing self-pity, the distortion of theories designed for the elimination of drinking so that they come to permit of light drinking once in a while.

This unconscious resistance against surrendering -- that is, being cured is nowhere better demonstrated than by avoiding work and being late for or breaking appointments, apparently always with the best of reasons.

There is a telling paragraph in Dr. Sigmund Freud's Introduction to Psychoanalysis: "If you were to come in contact with neurotics as a physician, you will soon cease to expect that those who complain most woefully of their illness are the ones who will oppose its therapy with the least resistance or who will welcome any help.

"On the contrary, you will readily understand that everything contributing to the advantage derived from the disease will strengthen the resistance to the suppression and heighten the difficulty of the therapy. We must also add another and later advantage to the gain of illness which is born with the symptom.

"If a psychic organization, such as this illness, has persisted for a long time, it finally behaves as an independent unit, it expresses something like self-preservation, attains a kind of modus vivendi between itself and other parts of psychic life, even those that are fundamentally hostile to it."

Of course a man cannot be expected to agree to do something until he knows of what it consists. Therefore one who has not been entirely convinced that he needs or wants help might be interested in a preliminary interview so that he can have first-hand information that may be of use to him some day, or that might entertain him as pure theory.

The attitude taken with such an individual is simply to answer his questions as fully as possible, discussing drink from any angle that he may wish. The accounts of changes in the lives of others more or less similarly situated may catch his attention and it may be possible thus inadvertently to "convert" him as to the advisability of seeking a cure.

He is definitely informed that he is not interviewing an evangelist, so that whether he wants to stop drinking or not is most decidedly his own business.

There is not the slightest desire or even willingness on my part to settle anybody's moral problems for them. If a person thinks he can drink, let him continue to do so.

He may be right, and at any rate it is his own concern. whether he is or not. If his condition is extreme, not from the point of view of prudes, but from that of his drinking friends, and he does not wish to correct it, then he is either insane or a moral delinquent, in which case his problem belongs in another field.

When, however, a man is doing something that his more intelligent self (which he would like to have as a permanently directing force) knows to be the height of inexpediency, and when he admits, furthermore, that he can do relatively little about checking this something in spite of his desire to do so, then and then only is the prospect favorable.

A person in the beginning cannot be expected to say that he wants to give up drinking in the broadest sense of the word, because if this were true he would promptly give it up without any difficulty and without any assistance, as obviously nobody compels him to drink.

But on the other hand he can say that he would like to be shown how to reconstruct his mental processes so that in due time he will no longer want to drink. This is what I mean by the necessary "surrender."