Unless a prospective patient is entirely on his own, a preliminary interview with his family or most intimate friend is most important. Much instructive material may be obtained from them which the patient cannot give, no matter how willing and honest he may be.

Frequently what he says and does when drinking is a valuable source of information. The inhibitions are lowered and the resulting speech and action may show clearly the repressions, somewhat in the manner of a dream but without its symbolization.

Inasmuch as the family interview often takes place after the patient has been treated several times, it must be stated plainly that the latter's private affairs can be told to nobody without his express permission and that he is only being discussed for his own good.

If this were not clearly understood, most people would disclose nothing of an intimate nature, and as a result the work would have to consist of persuasion devoid of analysis, with rather doubtful prospects of success.

Of even more importance than the information received are the suggestions which should be given the family to enable them to cooperate with the patient to the best advantage.

Another serious concern is the readjustment of the patient to his surroundings, of which the family is obviously the focal point. Where this is impossible, the surroundings themselves must be changed - a more difficult and less constructive performance, as it is often synonymous with hospitalization or permanent rustication in some remote spot.

I am using the word "changed" in its most comprehensive sense minor changes in the environment are nearly always necessary, and generally the most important of these is the facing of the problem by the individual's family and intimate friends in an intelligent and cooperative manner.

In the first place, it must be understood that the immediate results of the treatment are far from satisfactory to the layman.

There may be relapses throughout the first six months and sometimes these discouraging episodes are numerous and extreme. I say "discouraging" because that is the logical reaction of the uninitiated, but for those who have had experience with alcoholics these falls from grace are discounted in advance as being part of the normal procedure.

In nearly every case the individual is slowly weaned from his habit. He is not instantly checked. During this weaning process the change in the fundamental attitude toward drink is often further advanced than would appear in actual conduct, though it is of course recognized that conduct in the long run is the only criterion.

In two extreme instances which I can recall no sustained progress was made during the first year of effort. Then suddenly both individuals completely eliminated their habit.

As there was no sudden shock in either situation, the complete change of heart can only be explained on the grounds that the effects of the persuasion and the suggestion were accumulating in a mind that had been opened up by analysis, and when these suggestions became sufficiently strong the old habits yielded to them.

The first stage in the cure is reached when the patient abandons alcohol as a way of life, so that his upsets are actually life mistakes and not a continuation of his former method of environmental adaptation.

In the beginning the conduct itself may often be indistinguishable, but unless the patient is a liar (this trait is rare among alcoholics when they are sober, and when it exists the prognosis is very bad) it is easy enough to find out his fundamental attitude by asking him.

Relapses may continue after this important change has been made, but on recovery the patient reaches a different point of view: he has a sincere disgust at having been so stupid as to drink, a realization that the best part of his mind at least did not intend to do so, and a feeling that he got little or no satisfaction out of his "party" save in the early stages.

Moreover, if with this new suite of mind goes a recognition that he has had long periods of contentment without recourse to alcohol, the temporary reversion to former conduct may be discounted.

But if after two or three months of work the patient feels that his basic attitude has not changed, that such temperance as he may have shown has been purely a matter of annoying restraint, then it would he worth while considering if a continuation of the treatment were warranted.

This situation has not arisen yet. What should he done with the liquor in the house is apt to be one of the first questions asked. The answer is that such dramatic gestures as pouring it away are futile.

There is always plenty more obtainable around the corner. It is better to fight the battle out on the firing fine, unless the patient definitely feels that it would be easier to have as dry surroundings as possible during the first part of his rehabilitation.

If he does react in this manner he must say so frankly and without feelings of inferiority, for many first-class men have taken that attitude in the beginning, and it is only the stupid or insincere who force themselves beyond their limit.

But most men prefer to continue serving their friends in the customary manner. They get a certain stimulating satisfaction in refraining from drinking when there is plenty of it under their noses.

Best results are obtained, however, where this liquor is used in moderation as the sober view of "drunken parties" is apt to bore the non-drinking alcoholic just as much as it does any other non-participant.

As an escape from such boredom and as a result of concentrated negative suggestion the patient may be tempted to take refuge in the fatal "small one" as a means of adjusting himself to an annoying situation.

The inebriate who is attempting to overcome his habit must be given his way in regard to all things pertaining to an alcoholic environment. If he does not want liquor in the house, then obviously it should be removed.

Furthermore, if he wishes to give up going to the houses of others, or to any function where it may he served and which would bore him when sober, then those who are primarily interested in him must arrange matters so that he has his way without making him feel that he is selfish and narrow.

On the other hand, in this modern age, there is no reason why a wife who is well known in a community should not be free to enjoy herself as much as possible by carrying on her social life alone if necessary.

Because the alcoholic chooses, perhaps wisely, to withdraw temporarily or even permanently from wet social functions, there is no reason for his becoming a dog in the manger. (Incidentally this is not a common trait in alcoholics when they have made up their minds to stop once and for all.)

A woman may not want to leave her husband alone continually, but much of the time he should be glad to have her amuse herself in the manner to which she has been accustomed.

Whether a woman who drinks in moderation should become totally abstemious just because her husband cannot indulge himself without going to excess is a question to be decided on the merits of each particular case.

A woman under the influence of liquor is naturally of no help to a man who is trying to give up the habit. On the other hand, the last thing that most inebriates desire is to feel that because they themselves cannot take one drink without eventually becoming saturated their wives must forgo such pleasure as can be derived from one or two cocktails.

If a woman is actually dissipated she had better part company with her husband until he has had time to acquire a foundation of new habits.

However, I have not yet known of a situation where a relapse was brought about because of a mild indulgence on the part of the wife.

While, as I have stated, the inebriate in process of reconstruction must unquestionably be yielded to in matters that immediately concern drink.

He should not consider himself a hero and a martyr, and as a result use his praiseworthy efforts as a rod of iron with which to rule the home. Nor should he expect that just because he has stopped drinking everybody with whom he comes in contact is forthwith going to renounce all annoying traits and moods in deference to his change of heart.

After all, he is only doing the sensible thing from which he himself will derive the most profit, and he must realize that his relatives' troubles and worries do not cease with his temperance, no matter how much his former course of conduct may have contributed to their aggravation.

On the other hand, the alcoholic should always be dealt with honestly, even when he is under the influence of liquor. as he is apt to remember a deception in a way that will react unfavorably upon those who are trying to help him, even though the latter may feel with justification that their relative or friend while drinking has no "'rights."

For instance, if in order to get him home the alcoholic is told that he can have what he wants to drink when he gets there (provided he will stay there), then it should be given to him even if some friend has to go in search of another bottle.

This arrangement, of course, could not go on forever, but a physician can generally induce sleep before the individual has gone much further in drunkenness. I know of a case where an alcoholic went to an institution voluntarily on the condition that the doctor in charge would agree to his having four or five drinks on the day following his arrival and two or three the day after, a not unreasonable request.

The doctor., however, deliberately broke his word. The result was that the cure of the patient, which eventually took place elsewhere was indefinitely postponed because of the hostility engendered at what was justly considered the dishonest treatment received at the hospital.