The therapeutic problem is one of mental and emotional reintegration, which implies obviously that a disintegration of personality is found to some extent in each patient at the beginning of the work.

This disintegration shows itself in laziness and inefficiency, even when the alcoholic is sober. This it is absolutely necessary to correct. Of course there are some inebriates who from time to time introduce bursts of efficiency into an otherwise disordered life.

Then there are those who concentrate upon one form of "efficiency" so that it is almost a fetish. Neatness is a case in point. I have known drunkards who prided themselves upon their personal appearance at all times (except when they were so drunk that they did not know what they were doing), even though their life was crumbling about their ears.

But by and large the excessive drinker has lost his sense of values, he has no goal in life: he is entirely concerned with drinking, sobering up, and drinking again.

Everything else is of so little importance that it receives at best only a halfhearted Consideration, and, more often, none at all. The "conscientious" acts performed when under the influence of liquor would have been better left undone until sobriety was again attained.

The individual who leads this sort of inefficient existence, even when he is not an alcoholic, is flying in the face of an urge having almost instinctive force, for whenever we observe nature we note an orderly system.

This same methodical urge to be integrated exists in our characters. In olden times this question of conduct was such an obsession that the word "integrity" itself, which originally meant orderliness, came to assume a definitely ethical meaning.

Nowadays to be well organized is recognized as a concrete morns of existence rather than an abstract principle with religious overtones. Dr. Jelliffe and Dr. White, in the chapter on the Manic-Depressive psychoses in their book, Diseases of the Nervous System say, "The efficiency of one's relation to reality is the measure of one's normality."

Our problem is to substitute a benign for a vicious circle, and the key to this substitution is the employment of a method whereby a relative degree of efficiency will be achieved.

The drunkard must naturally sober up first; but, this having been accomplished, a new and more vigorous point of view must be injected into that period which heretofore has consisted in marking time in between "parties," to take the place of indifference, remorse, or hopeless discouragement.

If, during this interim, the reaction to life can be changed even slightly for the better, if some concrete action can be introduced into the daily attempt at normal adaptation which will give the patient the feeling "There is something constructive (dynamic and new)," then the cure may be said to have started.

I say "concrete" action because wise planning is a comparatively easy task for most people. In fact, it is so easy that all but the most vicious inebriates have been as full of lofty and sensible ideas as they have been of liquor, long before they have taken any constructive action about their problem.

But it is the execution of the plan that determines whether or not the initial theories were of any value. There must be action -- forceful, purposive, intelligent and sustained; and there is no better way to produce this action than to plan and execute one's life according to a self-imposed, prearranged schedule.

To be explicit:

before going to bed the patient should write down on a piece of paper the different hours of the following day, beginning with the time of arising. Then, so far as can be determined beforehand, he should fill in these hours with what he plans to do.

Throughout the day notations should be made if exceptions have occurred in the original plans, and it should be indicated whether these exceptions have been due to legitimate or rationalized excuses.

The latter must he avoided at all costs. Small as well as large activities that are taken up should not be dropped until completed unless they are in a sense unknown quantities, entered upon for purposes of investigation only.

Just how detailed the schedule should be depends somewhat upon the individual personality, for it is the spirit in which it is carried out rather than the letter of the law that is important.

Some people are made nervous by looking at the clock, and so they have better results if they merely put down what they intend to do in a semblance of order. The time method is the best, however, although it is desirable that the commitments should not be treated from a petty point of view, such as might create only an annoying reaction.

For instance, when a person has set aside the hours from three to five for he is not supposed to close his book promptly at five o'clock if a few minutes more will give him sufficient time to finish the chapter.

Moreover, there are business as well as social interests which cannot be terminated at any hour known in advance, as they depend upon other people who are not in any way interested in a schedule.

Obviously, under these conditions, question marks will have to be substituted for definite time limits, but this need not prevent the schedule from doing all that it is intended to do if such things as can be done are carried out in the proper spirit.

The schedule must he thorough: on it goes everything -- not only work and duty, but pleasure and rest, though the rest should he of a definite nature and not just loafing about.

At least one thing which must be done eventually, but which has been procrastinated because it is distasteful, should be included in each day's plan until all the pieces of an inefficient past have been picked up.

As far as notations go, I wish to repeat for emphasis that these will be determined by common sense, checked by the utmost personal honesty that can possibly be attained.

Most people in their hearts cannot really fool themselves unless they wish to. So the alcoholic should have no trouble in determining honestly whether a change in the schedule has been made for sensible and necessary reasons or whether it has come about through the reassertion of the old habits of laziness.

If logical, it should be made without hesitation, for the schedule has reason as its basis and not fanaticism; but ingenious as well as feeble excuses must be stringently suppressed.

The schedule contributes to the reintegration of character in three ways, all of them important. First, it prevents idleness.

This advantage is so obvious that I shall let a quotation from Dr. Stekel suffice for further comment. "Earthly happiness," he writes, "or that condition which we call happiness, is primarily dependent upon our relationship to time.

People who have no time, but, in spite of that, find time for everything they wish to do, are the happiest. There is no need for them to kill time.

They never get so far as to become conscious of it -- they know no boredom. Boredom is nothing else than consciousness of time."

Second, the schedule brings to the attention of the alcoholic the fact that he is doing something concrete about changing his condition, something more than mere discussion and reflection.

One of the chief difficulties of the treatment is its seeming vagueness outside of the central theme (abstinence), and so the more reality that can be brought into the work, the surer and quicker the favorable outcome.

As has been stated before, the alcoholic is more of a student than a patient, and he should never be allowed to forget that he is taking a course.

The third and most important of all reasons for employing the schedule is the training that it gives the individual in executing his own commands. It stands to reason that if ten or twenty times each day a person carries out a self-imposed direction, even though each of these directions may in itself be infinitesimal, a definite contribution has been made to the formation of a new character.

In battle it has been proved over and over again that large hordes of individually brave but untrained men can accomplish little when opposed by a smaller but disciplined military group. It takes plenty of close order drill before a regiment can go over the top, though the commands of that drill are never by any chance used in modern warfare.

So with the alcoholic and his temptation. He cannot expect consistently to conquer his enemy in every drawing-room and country-club porch if he has made no advance preparation.

He must do something more than theorize, important as that is, if he is going to pass through a cocktail barrage unscathed. In the end, to be sure, his abstinence will be the result of his not actually wanting to drink, but to reach that end successfully requires a disciplined personality.

That this training, if carried out over a sufficient period of time, will have ultimate results far exceeding that of mere sobriety goes without saying, but we will reserve discussion of that important "by-product" for a later period.

From my own point of view the schedule gives a very good indication of what may be expected from each particular patient.

A man who cannot or will not carry out such an important element of the work may be strongly suspected of being unsuitable material upon which to spend time and money either because of his constitutional makeup or because of lack of sincerity.