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Social characteristics of the skid row alcoholic : a survey of the characteristics and needs of a group… Cameron, Ronald Lloyd 1964

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SOCIAL CHARACTERISTICS OF THE SKID ROW ALCOHOLIC A Survey of the Characteristics and Needs of a Group of Alcoholics Living on Skid Row, Vancouver, B.C., I960. RONALD LLOYD CAMERON Thesis Submitted i n P a r t i a l Fulfilment of the Requirements for the Degree of MASTER OF SOCIAL WORK in the School of s o c i a l Work Accepted asr conforming to the standard required for the degree of Master of Social Work School of Social Work 1964 The university of B r i t i s h Columbia In presenting t h i s thesis i n p a r t i a l fulfilment of the requirements for an advanced degree at the University of B r i t i s h Columbia, I agree that the Library s h a l l make i t f r e e l y available for reference and study. I further agree that permission for extensive copying of t h i s thesis for scholarly purposes may be granted by the Head of my Department or by his representatives. It i s understood that copying or publication of this thesis for f i n a n c i a l gain s h a l l not be allowed without my written permission. The University of B r i t i s h Columbia, Vancouver 8, Canada. - i v -ABSTRACT T h e p r o b l e m o f a l c o h o l i s m i s a m a j o r h e a l t h c o n c e r n i n many c o u n t r i e s o f t h e w o r l d . The " s k i d r o w " a l c o h o l i c r e p r e s e n t s a m i n o r i t y o f a l l a l c o h o l i c s and s h o w s d e t e r i o r a -t i o n t o t h e e x t r e m e . T h i s s t u d y i s a s u r v e y o f a g r o u p o f " h a r d c o r e " a l c o h o l i c s who l i v e i n t h e d o w n t o w n a r e a o f V a n c o u v e r , B . C . W h i l e r e c o g n i z i n g t h e i m p o r t a n c e o f p h y s i o -l o g i c a l , p s y c h o l o g i c a l a n d p s y c h i a t r i c f a c t o r s , t h e s t u d y e v a l u a t e s t h e p r o b l e m m a i n l y w i t h i n a s o c i o l o g i c a l f r a m e o f r e f e r e n c e . I n p a r t i c u l a r , t h e c o n c e p t o f " r e t r e a t i s m " a s s e t f o r t h b y R . K . M e r t o n i s r e l a t e d t o s p e c i f i c c h a r a c t e r i s -t i c s o f t h e s k i d r o w a l c o h o l i c ' s s o c i a l f u n c t i o n i n g . The c h i e f s o u r c e o f t h e d a t a u s e d i s t h e r e c o r d s k e p t b y t h e V a n c o u v e r C i t y j a i l f o r t h e y e a r I960 a n d b e f o r e . T h e s e d a t a a r e l i m i t e d t o s u c h f a c t o r s a s a g e , e d u c a t i o n , a n d m a r i t a l s t a t u s . C o n s e q u e n t l y , e v a l u a t i o n o f t h e d a t a i s l i m i t e d t o e s t a b l i s h i n g t h e f a c t o f r e t r e a t i s m a n d r e l a t i n g t h i s t o p o s s i b l e e t i o l o g i c a l f a c t o r s i n t h e l i g h t o f i n f o r m a -t i o n f r o m o t h e r s t u d i e s . A s u r v e y o f t r e a t m e n t f a c i l i t i e s a n d r e s o u r c e s a v a i l a b l e t o t h e s k i d r o w a l c o h o l i c i l l u s t r a t e s a n e g a t i v e c o m m u n i t y a t t i t u d e t o w a r d t h e p r o b l e m . I t i s n o t e d t h a t w h i l e t h e p u b l i c a t t i t u d e t o w a r d a l c o h o l i s m a s a m e d i c a l a n d s o c i a l p r o b l e m i s c h a n g i n g , t h i s i s n o t r e f l e c t e d i n s e r v i c e s p r o v i d e d . B o t h g o v e r n m e n t a n d p r i v a t e a g e n c i e s r e g a r d t h e s k i d r o w a l c o h o l i c a s " h o p e l e s s " , a n d n o c o -o r d i n a t e d p r o g r a m i s i n o p e r a t i o n . E v a l u a t i o n o f t h e s t u d y i n d i c a t e s t h a t w h i l e t h e f a c t s do n o t s e r v e a s " p r o o f " o f M e r t o n ' s t h e o r y , t h e y a p p e a r t o b e c o n s i s t e n t w i t h t h e f o r m u l a t i o n o f t h e phenomena o f r e t r e a t i s m , a n d i m p l y a n e e d f o r f u r t h e r d e t a i l e d r e s e a r c h . F u r t h e r , t h e r e s u l t s a r e c o m p a r e d w i t h s i m i l a r s t u d i e s and a p p e a r t o b e s u f f i c i e n t l y c o n s i s t e n t t o i n d i c a t e t h a t t h e s k i d r o w a l c o h o l i c r e p r e s e n t s a n a t i o n a l p r o b l e m w h i c h i s c o s t l y a n d w a s t e f u l o f human r e s o u r c e s . The g r e a t e s t n e e d i s f o r p r o p e r a s s e s s m e n t , c o m b i n e d w i t h l o n g - t e r m t r e a t -m e n t a n d r e h a b i l i t a t i o n f a c i l i t i e s , t o s u p p l a n t t h e p r e s e n t " r e v o l v i n g d o o r " p o l i c i e s . P r e r e q u i s i t e t o t h i s , p u b l i c e d u c a t i o n m u s t b e a c c e l e r a t e d , s i n c e c h a n g e s i n c o m m u n i t y a t t i t u d e s a r e n e e d e d i f t h e s k i d r o w a l c o h o l i c i s t o be r e g a r d e d a s t h e p r o d u c t o f c u l t u r a l i n a d e q u a c i e s a n d n o t s i m p l y a s e x a m p l e o f i n d i v i d u a l " m o r a l w e a k n e s s " . - V -ACKNOWLEDGEMENTS I wish to express my thanks to Mr. N. Holland of the Vancouver C i t y Police Department, f o r his assistance on this project. Also, I would l i k e to express my appreciation to Mr. E.D. McRae of the Alcohol Foundation of B r i t i s h Columbia f o r his kind assistance. I wish to acknowledge my thanks to Dr. Leonard C. Marsh of the School of Soc i a l Work, fo r his a i d . I p a r t i c u l a r l y wish to thank Mr. Adrian Marriage of the School of Social Work whose able guidance and support made completion of t h i s thesis possible. - i i -TABLE OF CONTENTS Chapter 1. Background and Theory Page The problem of alcoholism. Contemporary fac t o r s . Uses and effects of alcohol. "Skid Row" -Vancouver. Community attitudes. Medical theories. Psychological theories. Social and c u l t u r a l f a c t o r s . Some conclusions 1 Chapter 2. The Characteristics of the Skid Row Alcoholic Nature of the survey. Age groups. Race, natio n a l i t y , r e l i g i o n , b i r t h place, education and occupational l e v e l s . Extent of involvement with the police and courts. The "typical" skid row a l c o h o l i c . Summary and significance of the data 23 Chapter 3. Treatment F a c i l i t i e s and Resources The a v a i l a b i l i t y of resources. Medical treatment of acute and chronic phases. Psychiatric treatment and f a c i l i t i e s . The role of the s o c i a l worker i n the ho s p i t a l . F i n a n c i a l aid and employ-ment. Role of missions and shelters. Police court and prison. Role of Alcoholics Anonymous. B r i t i s h Columbia Alcohol Foundation. The need for r e -evaluation 53 Chapter 4. Prevention, Treatment, Rehabilitation; What are the P o s s i b i l i t i e s ? Restatement of focus. A p p l i c a b i l i t y of theo r e t i c a l frame of reference. Evaluation of t r e a t -ment services and other resources. Implications of findings. Proposal for further study. Problem of prevention. Goals and objects of treatment and r e h a b i l i t a t i o n . S o c i a l r e s p o n s i b i l i t y 71 Appendices. Bibliography 93 - i i i -TABLES AND FIGURES IN THE TEXT Page (a) Tables Table 1. Age grouping (172 .men) 26 Table 2. Age grouping (12 women) 27 Table 3. Race and n a t i o n a l i t y (172 men) 29 Table 4. Religious a f f i l i a t i o n (172 men) 32 Table 5. B i r t h place (160 men) 33 Table 6. Length of residence i n Canada (45 men) . . . 34 Table 7. Education l e v e l (172 men) 36 Table 8. Occupational status (172 men) 41 Table 9. Employment status (172 men) 42 Table 10. Marital status (172 men) 43 Table 11. Next-of-kin (172 men) 46 Table 12. Residence of next-of-kin (75 men) 46 Table 13. Record of arrests (172 men) 49 Figure 1. (b) Figures Arrest frequences (172 men) 48 CHAPTER I BACKGROUND AND THEORY The problem of alcoholism is observed frequently by social workers, doctors and other professional people in their practices. In social agencies we see the tragedy, and personal and social disorganization which are the result of this i l lness . Many social workers consider alcoholism one of the most d i f f i c u l t illnesses to treat. But, while many professional people accept alcoholism as an i l lness , many lay persons see i t as a sign of moral weakness."*" That alcoholism is a species of weakness cannot be denied, but the cause of the weakness may be something for which the alcoholic could not be held morally responsible. The alcoholic who typifies in the public mind the image of a morally weak person is the "Skid Row" drunk. He is a degenerate, despised and disowned by the community. Sometimes he is granted pity, but even then his plight is seen as hopeless, except by a few. The "hidden" alcoholic i s perhaps better off, but he is con-stantly plagued by the fear that his "weakness" w i l l be d i s -1 The term "moral" suggests a value judgement and i ts meaning for different persons w i l l depend upon the particular mores of the group or sub-group in which the individual l i ves . Hence, i t is used here to suggest that acoholism is often viewed by many people in an emotional, rather than an analytical or objective l i ght . covered and he suffers constantly from self-condemnation. The present study i s concerned with the former group, the skid row a l c o h o l i c . Their numbers are fewer than the second group, but the problem created for society i s more s t r i k i n g , and i n many ways, more costl y . The purpose of the study i s to examine the characteristics of the skid row alcoholic i n r e l a t i o n to a s p e c i f i c t h e o r e t i c a l formulation, as well as t h e i r significance to the professions, the i n d i -vidual and the community. Before proceeding to t h i s , i t w i l l be h e l p f u l to examine some of the personal and s o c i a l aspects of the disease, and the part which alcohol plays i n s o c i a l organization. Contemporary Patterns Alcohol has, since ancient times, been used i n many ways by human s o c i e t i e s . It i s used i n r i t e s and ceremonies and s t i l l i s part of f e s t i v e and r e l i g i o u s celebrations. It i s sought a f t e r f o r medicinal purposes for such things as diabetes and as an anesthetic. Alcohol i s recognized as an e f f e c t i v e agent f o r " l u b r i c a t i n g " the wheels of s o c i a l i n t e r -action and today the term " s o c i a l drinking" has been coined. But men also r e a l i z e that alcohol has detrimental, as well I By "hidden" alcoholic i s generally meant the person who i s addicted to alcohol, but who i s able to maintain an acceptable l e v e l of s o c i a l functioning. That i s , he i s employed, usually married, maintains friendships, and his deterioration i s much les s extreme than that of the skid row a l c o h o l i c . Nevertheless, he i s i l l and represents the majority of a l c o h o l i c s . - 3 -as d e s i r a b l e , e f f e c t s . Some persons become o b j e c t i o n a b l e , abusive, and even dangerous when under the i n f l u e n c e of a l c o h o l . Others l o s e c o n t r o l of p h y s i c a l and mental co-o r d i n a t i o n . S t i l l others f i n d t h a t a f t e r prolonged use of a l c o h o l , they are unable t o do without i t ; even the s i m p l e s t t a s k s can not be confronted without the support of a l c o h o l . The u n r e a l i s t i c behavior of the a l c h o l i c and h i s compulsive d r i n k i n g h a b i t s o f t e n l e a d others to t h i n k of him as one who i s w i l l f u l l y f l a u n t i n g s o c i a l mores, values and t r a d i t i o n s , and he i s t r e a t e d as a s o c i a l o u t c a s t . T h i s a t t i t u d e toward a l c o h o l i s m f o r c e s the person to keep h i s a d d i c t i o n a s e c r e t and to r e s o r t t o t r i c k e r y and l i e s i n order t o p r o t e c t h i s s o c i a l s t a t u s . But i n some cases the a d d i c t i o n becomes so pronounced t h a t the person i s w i l l i n g t o g i v e up any c l a i m to the rewards which s o c i e t y has t o o f f e r i n order t o s a t i s f y h i s " h a b i t " . The more he i s abused because o f h i s d r i n k i n g , the more he uses a l c o h o l as a means of escape from the p a i n f u l r e a l i t i e s of s o c i a l l i f e . With i n c r e a s i n g i n d u s t r i a l i z a t i o n and u r b a n i z a t i o n , l a r g e numbers of these people d r i f t t o the poorer s e c t i o n s of towns and c i t i e s . Here they f i n d acceptance (or at l e a s t anonymity) among t h e i r own k i n d . G r a d u a l l y they g i v e up t h e i r a l l e g i a n c e t o the v a l u e s of the l a r g e r s o c i e t y . These people then, are the s k i d row a l c o h o l i c s , and every l a r g e c i t y has i t s s k i d row. The a l c o h o l i c shares h i s h a b i t w i t h hobos, p r o s t i t u t e s , beggars and mental d e f e c t i v e s - persons who a l s o are r e j e c t e d - 4 -by society or who have d i f f i c u l t y i n accepting and meeting the standards and values of the main culture. The alcoholic's t i e s with the community are slim and tenuous and emphasize society's r e j e c t i o n of and disgust for him. A major r o l e of law enforcement agencies i s to protect the community from these "bums" and i n very few c i t i e s does the police function serve as the f i r s t step i n a treatment program. The "missions", although well-meaning, have a re l i g i o u s purpose which, for the skid row al c o h o l i c , i s a reminder of the moral " t a i n t " he c a r r i e s . In thi s sense the a c t i v i t i e s of the "missions" are sometimes self-defeating. A summary view of skid row and i t s inhabitants as seen by the public i n general, i s given by Jackson and Connor: The Skid Row i s regarded as the area of the homeless man, of the 'bum' and the 'drunk', considered to be synonymous terms. The residents are held to be down and out, to have l o s t ambition, self-respect and other important values of our society, and to have d r i f t e d to Skid Road as the l a s t place where they could survive. There i s l i t t l e expectation that anything could be done to make these men members of the 'respectable' community again. The missions, the police , and the occasional non-religious charity organization have been l e f t to do any 'reforming' they can and t h e i r small success i s thought to confirm the impression that these men are hopeless. In t h i s , as i n other stereotypes, there i s just enough truth to make the whole stereotype appear convincing.! 1 Jackson, Joan K. and Connor, R., "The Skid Row Alcoholic" Drinking and Intoxication, Ed. McCarthy, R.G., Free Press, 1959, P. 314. This study i s concerned with these "exiles", but f i r s t i t is necessary to consider some facts about the total alcoholism problem so as to set the study within a broader context. Use and Effect of Alcohol The data which are now to be presented are based upon Popham's study."1" According to this author, Canada ranks f i f t h in alcohol consumption in comparison to other countries of the world. Prance, Italy, the U.S.A., and Switzerland are the four largest consumers. With regard to the rate of alcoholism, Canada is sixth, behind Prance, the U.S.A., Sweden, Switzerland and Denmark. The alcoholism rate for the years 1946 to 1948 was 1804 per 100,000 of the population aged 20 and over. This figure for Canada is increasing each year and from another study by Popham, i t appears that British Columbia has the most serious problem in comparison 2 with other provinces. In consumption of alcoholic beverages (beer, s p i r i t s , wine), British Columbia is second to Ontario. The per capita consumption in British Columbia for 1956 was 1.62 gallons of absolute alcohol. In that year the people of this province spent 3.8 percent of their income on alcohol. Further to this, British Columbia had the dubious distinction in 1955 of leading the rest of Canada with an alcoholism rate 1 Popham, R.E., "Canada", Drinking and Intoxication. Ed. McCarthy, R.G., Free Press, 1959, pp. 170-174. 2 Popham, R.E. and Schmidt, W., Statistics of Alcohol Use  and Alcoholism in Canada 1871-1956, University of Toronto Press, 1958, p. 155. - 6 -of 2,495 per 100,000 of the population aged 20 and over. What are the dimensions of the alcohol problem i n terms of law enforcement? In T946 the number of convictions for drunkenness was 5,974. In 1955 t h i s figure rose to 16,637 and represented 8 per cent of arrests f o r a l l offences. It i s d i f f i c u l t to estimate the cost of law enforcement, but as w i l l be shown the "revolving door" p o l i c y toward alcoholics i s expensive and achieves nothing. Policemen come to accept " p u l l i n g i n drunks" as a routine, tiresome part of t h e i r job, and i t i s inconceivable that they should be expected to main-t a i n a h e l p f u l attitude when they are f u l l y aware that arrest serves l i t t l e purpose. S p e c i f i c a l l y , i t does not serve the purpose of introducing the alcoholic to a treatment program. It does serve the purpose of reconfirming i n his mind feelings of worthlessness and r e j e c t i o n by society. Admissions to mental hospitals i s another index of the increase i n the alcoholism problem. In 1950, of 1854 f i r s t admissions to mental hospitals i n B r i t i s h Columbia, 104 were for alcoholism. Six years l a t e r , 436 of 2,547 f i r s t admissions were f o r alcoholism, an increase of 300 per cent. No doubt some of t h i s increase i s attributable to better service and increased acceptance of alcoholism as an i l l n e s s . Nevertheless, not a l l of the increase can be accounted f o r i n t h i s way. Upon examining the preceding figures, i t becomes obvious that alcoholism i s costing the community more and more each year i n human and economic waste. Further, there i s evidence that the resources presently available are i n -s u f f i c i e n t for coping with the problem. This i s p a r t i c u l a r l y so i n regard to the Skid Row alcoholic who i s f o r the most part, inaccessible to r e h a b i l i t a t i o n agencies. Having looked b r i e f l y at the problem of alcoholism i n general, i t i s now i n order to examine the skid row group s p e c i f i c a l l y . Skid Row - Vancouver As the largest centre i n B r i t i s h Columbia, Vancouver i s a t y p i c a l example of a community whioh has a serious problem with regard to i t s skid row. What i t cost the c i t y i n terms of law enforcement, crime, i l l n e s s , and wasted l i v e s , has not been estimated. But, as Marriage points out, "...We are sinking vast sums of money into a system which seems to y i e l d no discernible benefit to the community whatever.... ""*" One fact which seems to escape many people (as money-minded as we are i n our society) i s that, i n one way or another, the community must support the group of people who are residents of the skid row d i s t r i c t . The reluctance to spend money upon adequate treatment f a c i l i t i e s may seem inexpensive i n the short run, but i n the long run nothing i s achieved. Sara Harris bluntly describes what most communities have done about the problem. "Society's answer today i s the fl o p house or the prison c e l l , either of which i s calculated to make more 1 Marriage, Adrian, The Police Court Drunkenness Offender. 1957, p. 33. - 8 -certain the further degradation of these unfortunates."" 1' To gain evidence of t h i s f a c t , one needs only to spend a few hours i n the skid row area. In the year I960, there were 11,500 arrests for drunkenness i n Vancouver. Of that t o t a l , 7,690 arrests were 2 made i n a small area of f i f t y square blocks. This area i s bordered on the west by Richards Street, on the east by Gore Avenue, on the south by Pender Street, and on the north by the waterfront. This i s by s t a t i s t i c a l and popular d e f i n i -t i o n , the heart of Skid Row, Vancouver. Within t h i s area are the f l o p houses, the d i r t y streets, the cheap restaurants and bars. The d i s t r i c t borders upon the main shopping and business concerns of the c i t y and provides a sharp ( i f some-what depressing) contrast between s o c i a l r e s p e c t a b i l i t y and society i n i t s least respectable form. The arrest figures would indicate an increase i n the density of the population of the skid row, and point to certain conclusions. F i r s t , i t shows that the subculture i s self-perpetuating and more s o c i a l "rejects" are taking refuge there. Also, i t shows d e f i n i t e l y that the present methods of dealing with the problem are i n -adequate and i n e f f i c i e n t . And t h i r d l y , i t indicates, to some degree, the state of s o c i a l organization i n the main culture. 1 Harris, Sara, Skid Row. U.S.A.. New York, Doubleday, 1956, p. 12. 2 Holland, Norman, Police Court Clerk, Vancouver C i t y Police Department. Personal communication, March, 1961. - 9 -For the existence of skid row suggests that there is a need to take the time to evaluate the weaknesses in the culture which contribute to this phenomenon. The Community Attitude The community in general appears to see the skid row alcoholic in a pitying and "holier than thou" l ight . To many, the skid row alcoholic typifies fai lure to control external environment, and, what is more damaging, to control inner impulses and personal habits. Because of this , the skid row alcoholic is viewed as shift less , irresponsible and un-deserving of anything more than pi ty . There is a tendency for the community to evaluate the alcoholic on a negative emotional level rather than making a rat ional , objective assessment of his i l lness . Marriage, quoting from the results of a Gallup P o l l taken in Canada in 1957, points out that only 70 per cent of those polled had heard of "alcoholism." Of these, only 24 per cent were of the opinion, that alcoholism is a disease."1" Hence, there is much progress s t i l l to be made in our culture. Some forward steps are being taken as is reflected by the establishment of the Br i t i sh Columbia Alcoholism Foundation. More w i l l be said concerning treatment f a c i l i t i e s in a later chapter. 1 Marriage, The Police Court Drunkenness Offender, p. 25 Medical Theories - 10 -There i s no doubt that alcoholism i s , i n part, a medical problem. Pew persons need a medical degree to recognize the physiological manifestations of al c o h o l i c over-indulgence. Slowed reaction time, d i s t o r t i o n of v i s u a l , sensory and auditory perception, impairment of co-ordination, and the decreased a b i l i t y to think reasonably, are evidence of the bodily changes brought about by alcohol. More serious effects such as delirium tremens, hallucinations and "black outs" are usually not experinced by the " s o c i a l drinker." But they are a common occurrence for the skid row alcoholic, who w i l l go to the extremes of drinking shoe pol i s h , or inhaling paint fumes to get r e l i e f from his craving. It has been stated that at lea s t 12,000 people diew each year i n the U.S.A. from chronic alcoholism. 1 This figure does not include those deaths which are the in d i r e c t result of excessive drinking, such as automobile accidents. It i s safe to assume that many who die from chronic alcoholism are skid row d e r e l i c t s . Even here though, there appears to be some doubt as to whether many of these deaths are d i r e c t l y due to alcoholism per se. Marriage points out that such con-ditions as Korsakoff's psychosis, alcoholic paranoid states, 1 Noyes, A.P. and Kolb, L .C, Modern C l i n i c a l Psychiatry, Chapter X, p. 191. - 11 -delirium tremens, pellagra, polyneuropathy, and c i r r h o s i s of the l i v e r r e s u l t , i n part, because the alcoholic ignores his physical care f o r the sake of obtaining a l c o h o l . 1 Nonethe-l e s s , whatever the contributory factors, there can be l i t t l e argument that alcoholism i s a health problem. With regard to n u t r i t i o n a l , glandular and genetic factors, few theorists 2 would state these as a main contributor to the disease. Some speculate that while alcoholism i s not d i r e c t l y inherited, the person may have a genetic predisposition toward a psychic make-up which makes him more susceptible to alcoholism. As we understand more f u l l y and accept the i n d i -v i s i b i l i t y of mind, body, and s o c i a l environment, we must necessarily view alcoholism as a physical, psychological and s o c i a l disease. Any program which ignores t h i s fact i s severely limited i n what i t can do. It i s generally agreed that most alcoholics begin drinking because of psychological and/or s o c i a l factors. As he becomes addicted to alcohol, the i n d i v i d u a l developes a craving which, i n part, i s physio-l o g i c a l . The skid row alcoholic must be c l a s s i f i e d as a person who has reached t h i s l a t t e r phase. This i s not to say that psychological and s o c i a l factors are any l e s s important on that account, but i t does indicate that t r e a t -ment i s much more d i f f i c u l t . 1 Marriage, The Police Court Drunkenness Offender, p. 18. 2 McCord, W. and McCord, J. with Guderman, J . , "Some Current Theories of Alcoholism: A Longitudinal Evaluation", Quarterly  Journal of Studies on Alcohol. Vol. 20, No. 4, Dec. 1959, pp. 727-749. - 12 -Psychological Theories There are numerous theories, psychological and psychiatric, which attempt to give a dynamic picture of the etiology of alcoholism. The d i v e r s i t y of views i s due not only to the wide v a r i a t i o n i n symptomatology at di f f e r e n t stage of the disease, but also because of the confusion with-i n the f i e l d of psychology and the paucity of s c i e n t i f i c facts regarding peoples behavior. The Freudian view proposes that alcoholism i s primarily an expression of repressed homo-sexuality, and although those analysts who agree with t h i s view recognize that other factors must be taken into con-sideration, they assign the major r o l e to that played by the homosexual repression. 1 Rosenman, i n his postulation of the "negative ego image", states that r e j e c t i o n of the male c h i l d 2 by the father i s most s i g n i f i c a n t . Gibbins, i n his survey of the l i t e r a t u r e on the etiology and treatment of acoholism, has t h i s to say about psychoanalytic theories, It i s probably true that none of the psycho-analytic theories discussed here reveal any of the s u f f i c i e n t conditions for the genesis of alcohol addiction. A l l the developmental elements which have been invoked as e t i o l o g i c -a l may be found i n behavior disorders of quite a d i f f e r e n t nature. Generally speaking, the analysts have only touched upon the necessary conditions of abnormal behaviour.3 1 Gibbins, R.J., Chronic Alcoholism and Alcohol Addiction, Alcohol Research Pound, of Ont., 1953, p. 7. 2 Rosenman, S., "The Skid Row Alcoholic and the Negative Ego Image", Quarterly Journal of Studies on Alcohol, Vol. 16, No. 3, Sept. 1955, p. 450. 3 Gibbins, Chronic Alcoholism and Alcohol Addiction, p. 10. - 13 -English and Pearson say that i n regard to etiology, A regression to an oral a c t i v i t y takes place i n the a l c o h o l i c . The habit of drinking -having something go into the mouth and down the throat - has a great deal of meaning fo r these people. In infancy we were warmed and made comfortable by drinking milk and being nursed by the mother. And i n the same way that these attentions quieted the anxiety of the infant, so does drinking l i q u o r f u l f i l l the alcoholic's present need. Alcohol acts as a narcotic; i t a f f e c t s the brain and deadens, f o r the moment, the painful impressions of unhappiness that have been b u i l t up with the years.1 Other psychological views which are widely held are those which view parents as having f a c t u a l and moral r e s p o n s i b i l i t y f o r alcoholism i n t h e i r children, those which a t t r i b u t e the disease to a basic i n s e c u r i t y i n the c h i l d , those which phrase the problem i n terms of introversion and extroversion, and those which view alcoholism as a repression of inner impulses. It i s probably true that most of these theories embody part of the t o t a l picture, but as Gibbins goes on to say: A perusal of the psychological l i t e r a t u r e on alcohol addiction leaves one with the impression that many writers are evading the central issues of the problem. Numerous are those published a r t i c l e s which enumerate the personality t r a i t s of the al c o h o l i c and describe his behaviour. What motivated the person pathologically, they usually neglect to say. More important i s the fact that the personality characteris-t i c s of the alcoholic can be interpreted as 1 English, O.S. and Pearson, G.H.J., Emotional Problems of  L i v i n g . Horton, N.Y., Rev. Ed. 1956, p. 501. - 14 -the result of his alcoholism rather than as e t i o l o g i c a l factors i n i t s development.1 Mc Cord, Mc Cord and Guderman who compared the back-grounds of 29 alcoholics with 158 men who were neither alc o h o l i c nor criminals state that there i s no evidence to l i n k o ral tendencies, latent homosexuality or maternally 2 encouraged dependency to alcoholism. Their findings did indicate a relationship between strong s u i c i d a l tendencies and alcoholism, as well as between strong i n f e r i o r i t y feelings and alcoholism. It would be an extensive theory indeed which accounted for and explained a l l the e t i o l o g i c a l variables which are of importance. It i s true that there i s a need f o r a uni f i e d theory (which explains a l l the f a c t s ) , but t h i s can only be done as s p e c i f i c aspects of the i l l n e s s are studied and the results co-ordinated. This study i s an attempt to explore the application of one t h e o r e t i c a l perspective to a p a r t i c u l a r group of alcoholics - the skid row drunk. So c i a l and Cultural Factors Having reviewed b r i e f l y the l a y attitudes and medical and psychological views of the alcoholism problem, i t i s now 1 Gibbins, Chronic Alcoholism and Alcohol Addiction, p. 14. 2 Mc Cord and Mc Cord with Guderman, "Some Current Theories of Alcoholism: A Longitudinal Evaluation", p. 745. - 15 -i n order to examine s o c i a l and c u l t u r a l factors. Gibbins has the following to say concerning these factors. Most writers on the subject pay at least l i p - s e r v i c e to s o c i a l factors as e t i o l o g i c a l elements, but there are few who have given recognition to these factors as p r i n c i p a l ones, or have given the matter the considera-t i o n i t deserves.1 Such factors as poverty, occupation and education, are recognized as important but do not go f a r i n explaining etiology. In t h i s study, these factors w i l l be used as c r i t e r i a f or measuring a more basic s o c i a l phenomenon. Of prime importance to the understanding of the alcoholic i s a knowledge and grasp of the fundamental value-system of the society i n which we l i v e . It i s postulated that there are certain aspects of t h i s value system which are important i n helping us to understand the phenomenon of skid row alcoholism. In exploring t h i s question, i t i s proposed to examine and evaluate R.K. Merton's theory of " s o c i a l retreatism." The theory i s e s s e n t i a l l y s o c i o l o g i c a l and around i t can be constructed a framework i n which the cha r a c t e r i s t i c s of the skid row alcoholic can be explored. It does not subtract from or supplant the psychological and medical theories, but i t adds an important dimension to our conception of t h i s group of s o c i a l m i s f i t s . 1 Gibbins, Chronic Alcoholism and Alcohol Addiction, p. 18. - 16 -Merton discusses the meaning of deviations (alcohol-ism i s a form of deviation) i n s o c i e t y . 1 He maintains that in d i v i d u a l or group deviation from c u l t u r a l "norms" cannot be s o l e l y attributed to the c o n f l i c t between the individual's impulses and the r e s t r a i n t s of society (as Freud maintained). The very fact that deviant behaviour varies systematically i n d ifferent cultures suggests that i t must be due, i n part, to the very structure of the society. With alcoholism, f o r example, the chances of a person becoming a drunk are greater or l e s s , according to the culture i n which he l i v e s , and more p a r t i c u l a r l y to that part of the s o c i a l structure i n 2 which he finds himself. Thus, etiology must include not only psychic factors, but also factors inherent i n the structure, value system and goal orientations of the society. Merton suggests that there are two basic elements which are common to every society. F i r s t , every society sets up, or defines goals which are considered desirable for every individual i n the s o c i a l structure. There i s usually a h i e r a r c h i c a l structuring of the goals which are valued i n the society. The second tenet i s that there are, i n every culture, i n s t i t u t i o n a l i z e d means of attaining the valued 1 Merton, R.K., S o c i a l Theory and S o c i a l Structure. Free Press 111., 1957, pp. 153-155. 2 It should be noted that not every society establishes universal goals, but that t h i s i s peculiar to the North American si t u a t i o n , p a r t i c u l a r l y i n a h i s t o r i c a l sense. For example, i n medieval England each class within the culture establish i t s own goals for persons i n that c l a s s . - 17 -goals, aims or purposes. As well as f a c i l i t a t i n g the a t t a i n -ment of goals, the i n s t i t u t i o n a l i z e d means control and l i m i t the ways i n which an in d i v i d u a l may s t r i v e toward the goal. But, there i s not a one-to-one correspondence between c u l t u r a l l y approved goals and i n s t i t u t i o n a l means. That i s , The c u l t u r a l emphasis placed upon certa i n goals varies independently of the degree of emphasis upon i n s t i t u t i o n a l i z e d means. There may develop a very heavy, at times a v i r t u a l l y , exclusive stress upon the value of p a r t i c u l a r goals, involving comparatively l i t t l e concern with the i n s t i t u t i o n a l l y prescribed means of s t r i v i n g toward these goals.1 Societies vary i n the degree of functional co-ordination between valued goals and the i n s t i t u t i o n a l i z e d means of atta i n i n g these goals. The existence of gaps or discrepancies between the two i s alleged as the root cause of deviant behavior. Probably the highest value we hold i n i n d u s t r i a l western socie t i e s i s that of success i n i t s e l f . It i s emphasized and reemphasized i n many ways throughout the culture. A person may achieve prestige i n anything as long as he i s a success at i t . Our motto i s , "anyone can reach the top", but the facts would make i t obvious that t h i s i s not turoe. Hence, an imbalance i s created as everyone i s exhorted to become a "success" while the i n s t i t u t i o n a l means of doing so are denied or are inaccessible to many. And 1 Merton, So c i a l Theory and Soc i a l Structure, p. 133. - 18 -even f o r those who have access to the means, the competition f o r the prestige position i s often great and f r u s t r a t i n g . The class structure of our society i t s e l f i s a b u i l t - i n l i m i t a t i o n to the p o s s i b i l i t y of ce r t a i n individuals and groups achieving the success-goal by the means which are legitimately a v a i l a b l e . The value system takes no account of t h i s and those who cannot move up the s o c i a l ladder are denied the prestige of those born into the upper classes. The lower-class person i s measured by the same "yard s t i c k " as the upper-class person. Society has much the same expectation regardless of the person's position on the s o c i a l scale, although the expectation may be modified to some extent, depending upon the group climate i n which the i n d i -v idual functions. And i n our culture, most people have internalized these values and expectations so the success-goal i s important to the motivational system of most members of the population. One of the major c r i t e r i a by which success i s measured i n the North American culture i s that of money. The i n d i -vidual's prestige i s gauged according to the size of his i n -come and i n many instances "monetary success" i s seen as a goal i n i t s e l f , rather than the means to an end. This i s not to say that wealth i s the only indicator of success - others are: education, profession, and s o c i a l standing. It i s often maintained that this seeking f o r prestige and status i s not necessarily undesirable or destructive. But the problem - 19 -arises when anxiety i s created by the i n a b i l i t y of some persons to achieve success by the conventionally legitimate means. Whether or not there i s any hope of achieving success, the i n d i v i d u a l i s pressed to c l i n g to the goal orientation. Not to do so results i n s o c i a l and personal f a i l u r e . There-fore, the i n d i v i d u a l who values the success-goal and yet i s denied the legitimate means of attaining the goal must necessarily become frustrated. He must then make some kind of adaptation to the f r u s t r a t i o n and inadequacy he f e e l s . Merton formulates f i v e main types of adaptation which the i n d i v i d u a l may make. He cautions that these are "ideal types" and there i s usually some overlap, depending on the kind of s i t u a t i o n i n which the person finds himself. It w i l l depend also upon the psychological and physical cha r a c t e r i s t i c s of the person, and w i l l vary according to his s o c i a l position. He maintains, though, that a given i n d i v i d u a l w i l l use one mode of adaptation predominantly. The f i r s t adaptive pettern i s that of "conformity" and i s used by the majority of the people i n a stable culture, where equal value i s given to the goals and i n s t i t u t i o n a l means. In t h i s sense, he considers conformity a "normal" adaptation, and the other four are forms of deviance. Second i s "innovation" which occurs when there i s i n t e r n a l i z a t i o n of c u l t u r a l goals without equal i n t e r n a l i z a -t i o n of i n s t i t u t i o n a l i z e d means. Following this pattern, the in d i v i d u a l may achieve the success-goal through i l l e g i t i m a t e means and s t i l l maintain high s o c i a l prestige. An example i s - 20 -the business man who uses i l l e g a l or unethical methods to s e l l his product. The t h i r d adaptive pattern i s that of "ritualism", where there i s an int e r n a l scaling down of c u l t u r a l goals and a heavy emotional investment i n i n s t i t u t i o n a l i z e d means. In th i s way, the person avoids the competition involved i n s t r i v i n g for c u l t u r a l l y valued goals. The person i s able to ra t i o n a l i z e h is fear of f a i l u r e . A fourth mode of adaptation i s " r e b e l l i o n " where the indi v i d u a l condemns both c u l t u r a l l goals and means and wishes to a l t e r the structure of the society. This could, i n the extreme view, r e s u l t i n s o c i a l revolution. It i s on the pattern of adaptation which Merton c a l l s "retreatism" that t h i s study i s based. The skid row alcoholic t y p i f i e s , to a large extent, the kind of in d i v i d u a l who uses t h i s means of escaping the c u l t u r a l demand for success and prestige. Of these people, Merton says, They have relinquished c u l t u r a l l y prescribed goals and t h e i r behaviour does not accord with i n s t i t u t i o n a l norms. This i s not to say that i n some cases the source of t h e i r mode of adaptation i s not the very s o c i a l structure which they have, i n effect, repudiated, nor that t h e i r very existence within an area does not constitute a problem for members of the society.1 These people have internalized (in the f i r s t instance) both the valued goals and i n s t i t u t i o n a l i z e d means. But the means do not lead to success f o r them, and because of the g u i l t 1 Merton, So c i a l Theory and Soc i a l Structure, p. 158. which arises i f they attempt to u t i l i z e i l l e g i t i m a t e means, they attempt to find another way to escape the f r u s t r a t i o n . The r e s u l t i s that they withdraw e n t i r e l y t h e i r involvement i i n the i n s t i t u t i o n a l i z e d means and c u l t u r a l goals. The alcohol i c uses alcohol i n order to ease the g u i l t and inadequacy he feels i n doing t h i s . As Merton points out, these people "are i n society but not of i t . " The person i s , of course, condemned by the culture because he rejects that which society values greatly. He i s not only a l i a b i l i t y , but conversely serves as a reminder that there are serious weaknesses i n society's value structure, which have contributed to his i l l n e s s . He has given up any claim to the rewards which society has to of f e r , but i n doing so, he has also escaped the f r u s t r a t i o n that the competitive, unbalanced struggle e n t a i l s . Merton's formulation gives insight into the etiology of alcoholism, p a r t i c u l a r l y as observed i n the skid row d e r e l i c t . Every facet of his functioning i s a repudiation of those goals and i n s t i t u t i o n s which society values. The theory suggests that the s o c i a l structure i t s e l f plays a large part i n the i n i t i a l and continuing deviation of the skid row a l c o h o l i c . Alcohol offers a defence which allows the drunk to escape from the demands of the culture. Alcoholism i s a vicious c i r c l e , f o r while i t brings censure upon the person suffering from the i l l n e s s , i t also provides him with a b a r r i e r against that condemnation. This suggests why r e h a b i l i t a t i o n of the skid row a l c o h o l i c i s a d i f f i c u l t and - 22 -sometimes impossible task. Rehabilitation implies that the alcoholic be brought back into a society from which he i s tr y i n g to escape i n the f i r s t place. Hence, not only must the in d i v i d u a l be helped to use i n s t i t u t i o n a l means e f f e c t -i v e l y , but i t also i s suggested that changes within the society i t s e l f are necessary so as to reduce the number of persons affected adversely. Conclusion In t h i s chapter the dimensions of the alco h o l i c problem i n B r i t i s h Columbia have been examined, looking s p e c i f i c a l l y at the skid row drunk, an attempt has been made to examine t h i s problem within the framework of a s o c i o l o g i c a l theory, emphasizing those factors which seem to be of causal si g n i f i c a n c e . In the following chapter, data obtained from l o c a l police records w i l l be evaluated i n terms of the " r e t r e a t i s t " behaviour of the a l c o h o l i c . The c h a r a c t e r i s t i c s examined w i l l be those which indicate the person's effectiveness i n performing c u l t u r a l l y accepted r o l e s . In the t h i r d chapter, a survey w i l l be made of the present treatment f a c i l i t i e s i n Vancouver and they w i l l be evaluated with special reference to the help given the skid row drunk. The f i n a l chapter i s a summing up of the significance of the study for s o c i a l workers, other professions and the community as a whole. CHAPTER II THE CHARACTERISTICS OP THE SKID ROW ALCOHOLIC In Chapter I some of the facts, attitudes and theories concerning alcoholism were examined. In p a r t i c u l a r , R.K. Merton 1s theory of s o c i a l "retreatism" was given as a theoret-i c a l base f o r studying the characteristics of the skid row al c o h o l i c . Accordingly, i n the present chapter a limited analysis of the role performance of the skid row alcoholic i s presented with the object of evaluating the extent to which the phenomenon of retreatism i s operating. As to the timing of the present study, i t i s the writer's opinion that the problem has been neglected too long. With the continuing increase i n the number of skid row alcoholics, the need f o r a thorough study i s es s e n t i a l . E.D. McCrae has suggested that such a study would cost approximately $15,000.1 The present study i s much less ambitious but i t does establish certain trends and shows that a more detailed examination of t h i s subculture should be made. Form of the Study The sample was selected from the records of the Vancouver Police Department. The j a i l department maintains 1 The Vancouver Sun. March 12, 1961, p. 22. a card index system i n which the name, hirthdate, and number of those arrested for drunkenness (state of intoxication i n a public place, or SIPP) are kept. In these f i l e s are kept approximately f i v e thousand in d i v i d u a l cards and from these were selected 184 cases (172 males and 12 females). The card index system has been kept since 1955 and each time a person i s arrested the arrest sheet number and date of arrest i s recorded on his or her card. It was thus possible to select the sample on the basis of the number of arrests and then to cross-check the arrest sheet number with the o r i g i n a l arrest sheet. These sheets are completed each time a person i s arrested and the information given i n t h i s chapter i s based upon the data from them. The arrest sheets do not give a s o c i a l h i s t o r y - they deal with objective facts about the person such as age, sex, marital status and education. The primary c r i t e r i o n for selection of eases was that the person had been arrested for drunkenness no less than f i v e times i n I960. This was f e l t necessary i n order to ensure the elimination from the study of the "occasional drunk", and to select individuals who were t r u l y represent-ative of the skid row alc o h o l i c population. For reasons of convenience, no attempt was made to obtain a random sample. Cards from each alphabetical category were selected according to the number of arrests, with the res u l t that many cards were selected from some alphabetical categories with few from others. This creates some bias i n the sample but the primary purpose of se l e c t i n g hard core alcoholics was achieved. The selection of twelve females was based on the fact that of the 11,500 arrests i n I960, only 1,120 were women.1 The small number of women i n the sample makes i t d i f f i c u l t to draw any firm conclusions and only suggests possible trends. There are certain l i m i t a t i o n s i n the data which should be c l a r i f i e d . Many of the men were too drunk at the time of arrest to give the information needed to complete the arrest sheets. At f i r s t t h i s appeared to be a serious drawback, but since most of the men and women have arrest records of long-standing and are well-known to the pol i c e o f f i c e r s , the information could be v e r i f i e d from previous contacts. Con-sequently, I do not f e e l that the information i s made i n v a l i d or useless, as i t seems u n l i k e l y that f a l s i f i c a t i o n of thi s objective material occurred. Another point which should be noted i s that the data do not define the causal or e t i o l o g i c a l factors. What they do i s suggest areas which are of importance i n evaluating present functioning. Since the emphasis i s on present functioning, there i s only the length of the arrest record to suggest how long these people have been on skid row, and how long they have been a l c o h o l i c s . Keeping these points i n mind, i t i s now i n order to evaluate the information which was gathered about t h i s group of alc o h o l i c s . 1 Edwards, A., Vancouver Police Court, Interview, February, 1961. - 26 -Age The age groupings are of significance in that they show that the majority of these men have reached middle age and yet have not achieved the measure of "success" which might normally he expected. Most men in our society, by this time, have become well established in their occupation and i n their marriages, and are concerned with planning for the future of their wives and children. The main concern of the skid row alcoholic at this age is where he w i l l obtain his alcohol. He is not involved in the ends and means of social l i v i n g . As is shown by Table 1, the majority of the male skid row alcoholics are in the 40 to 54 year age group. Another 22 per cent are 55 or older. Table 1. Age grouping of 172 Male  Skid Row Alcoholics Age Number of cases Percentage 25-29 8 4.7 30-34 18 10.5 35-39 22 12.8 40-44 36 20.9 45-49 19 11.1 50-54 31 18.0 55-59 13 7.5 60-64 14 8.1 65-69 9 5.2 70-74 2 1.2 Total 172 100.0 - 27 -Table 2 gives the age grouping of the women, and i t is significant that 83 per cent of the women are below the age of forty as compared to only 22 per cent of the men. 1 She mean age for the men is 46.3 and the median age 45.5 while the mean for the women is 32.2 and the median is 30. Although the number of women in the sample is small, i t does suggest that women who become skid row alcoholics reach the row at a much earl ier age than do men. It also seems to indicate that other factors (e.g. prostitution) may be of primary importance with women and that their alcoholism is a secondary development. There would appear to be essential differences in the reasons for the withdrawal of women from normal social interaction. This is particularly true for the Native Indian woman who faces more severe problems in adapting to sdcial demands. Table 2. Age Groupings of 12 Female Skid Row Alcoholics Age Number of cases Percentage 20.24 3 25.0 25-29 2 16.6 30-34 4 33.4 35-39 1 8.3 40-44 0 — 45-49 1 8.3 50-54 0 — 55-59 1 8.4 Total 12 100.0 1 As noted previously, there is such a large difference in the sizes of the two groups, i t is impossible to draw any definite comparisons or conclusions from these figures. - 28 -Comparing these figures with those given by Kelly in his study of 250 patients undergoing treatment for alcoholism in the Butner C l i n i c , North Carolina, i t would appear that the skid row alcoholic is four to five years older than the average c l in i c pat ient . 1 Further, the figures given in Table 1 agree generally with those given by Straus in his 2 study of 203 homeless man. F ina l ly , the fact that less than 5 per cent of the men reached skid row before the age of th irty shows that the escape adaptation is a slow process, probably involving many frustrations and fai lures . Race of Nationality As with many other studies, the present one provides evidence that the Irish male in this country is often l ike ly to become a skid row alcoholic. Table 3 shows that 21.5 per cent of the men in the sample are of Ir i sh decent. This high incidence is explained in most studies by suggesting that there are basic factors of the Ir i sh culture which i l l -prepare the men to compete in a culture such as ours. Although the majority of the men in the present study were bom in Canada this does not necessarily refute the argument. It appears 1 Kel ly , N . L . , Alcoholism and Social Experience, North Carolina Alcoholic Rehabilitation Program, 1954, p. 21. 2 Straus, R. , "Alcoholism and the Homeless Man"., Quarterly Journal of Studies on Alcohol, Vo l . 1, No. 3, Dec. 1946, p.369. 3 Ib id . . p. 385. - 29 -l o g i c a l that since most would be children of people who were born i n Ireland, then there would be allarge residue of the c u l t u r a l values and t r a d i t i o n s which are carried over from the parents. That i s , c h i l d r a i s i n g methods, values and goals would probably be quite s i m i l a r to those i n Ireland. Table 3. Race and Nationality Groupings of  172 Male Skid Row Alcoholics Race or Nationality Number Percent I r i s h 37 21.5 Scot t i s h 31 18.0 Native Indian 25 14.5 French 19 11.0 Scandinavian* 17 10.0 English 15 8.7 Russian 7 4.0 Others** 21 12.3 Totals 172 100.0 * This group includes: Swedes (7), Fins (1), and Norwegians (9). ** This group includes: Hungarians, Ukranians, Austrians, Germans, Negroes, Swiss, Poles, Lithuanians, Slavs, Rumanians, Icelanders, Welsh and Dutch. The maximum number i n any of these groups i s three. It i s d i f f i c u l t to account f o r the large number of men of Scottish descent i n the study. I t i s suggested that t h i s i s i n keeping with the proportion of Scottish males i n the general population. In t h i s study, as i n others, the Jews are noticeable fo r t h e i r absence from the skid row population. Also, members of Oriental and other Asian groups do not tend to become skid - 30 -row inhabitants. Even where they do reside on skid row, they are usually not alcoholics. The reasons why these people do not become alcoholics w i l l not be discussed here. The purpose in mentioning them is that i t does reinforce the view that skid row and alcoholics who l ive there are an expression not only of intrapsychic factors but also of cultural influences. As is shown by Table 3 , the Indian population of Br i t i sh Columbia is well represented on skid row, Vancouver. Native Indians comprise 14.5 per cent of the male sample and are the third largest group. This indicates a str iking over-representation of the Native Indian population. This is born out when compared with census f igures . 1 The expected propior-tion would be 2 per cent rather than the 14.5 per cent indicated. Of the females, 8 are Native Indians. There appear to be several factors which help to explain why Indians become skid row alcoholics. They have a low socio-economic status, their culture is quite different from the main society, many of the males are loggers or fisherman (groups notable for their drinking habits), they are poorly educated and usually unskilled, and they are expected to l ive according to the values of the over-culture. With this group i t would appear that skid row degradation is the result of a cultural conflict where they are unable to adapt to the main culture 1 Canada.; Year Book. Dominion Bureau of Stat is t ics , Queen's Printers, 1962, p. 1203. - 31 -and are d i s s a t i s f i e d with being a member of a minority group. Therefore, i n a l l three major groups i t i s suggested that c u l t u r a l factors are as important as psychological factors i n the etiology of skid row alcoholism. Religion Religious b e l i e f and a c t i v i t y are generally accepted as one c r i t e r i o n f o r measuring the individual's involvement i n s o c i a l l i f e . Prom the e a r l i e s t years of an individual's l i f e , he i s aware of the importance of re l i g i o u s values. As a society, our re l i g i o u s heritage i s of major significance i n attaching moral overtones to behavior. H i s t o r i c a l , technical and s o c i a l changes have modified these b e l i e f s to some extent, but the value system of society i s based upon Christian i d e a l s . On a conscious l e v e l i t appears that the alcoholic has relinquished his allegiance to these b e l i e f s . Nevertheless, further study i s needed to determine the true significance of r e l i g i o u s b e l i e f s and ideals to these i n d i -viduals, p a r t i c u l a r l y upon an unconscious l e v e l . Table 4 shows the numbers of men who profess to be-long to d i f f e r e n t f a i t h s . The predominance of Catholics i s i n agreement with other studies, as quoted by Straus. 1 On the other hand, Kelly's study of a group of 250 patients undergoing treatment at Butner, North Carolina revealed that 1 Straus, "Alcoholism and the Homeless Man", p. 384. - 32 -only 1.9 per cent were Catholic. Also, Feeney's study of a group of chronically j a i l e d alcoholics shows that only 18 per 2 cent were Catholic. The v a r i a t i o n i n study results indicates that r e l i g i o u s a f f i l i a t i o n i s a dependent variable according to r a c i a l grouping or geological location and i s not s i g n i f -icant insofar as general etiology i s concerned. That i s , although r e l i g i o n may be a factor i n individual etiology, there i s no p a r t i c u l a r denomination which is more predisposed to alcoholism than another. The arrest sheets give no i n d i c a -t i o n as to whether a man was active with regard to r e l i g i o n , but the author believes i t can be s a f e l y assumed that the majority are non-practicing. It i s l i k e l y that many would "change" t h e i r r e l i g i o n , depending upon the r e l i g i o u s group that i s giving them food, clothing or meeting other needs. Table 4. Religious Denominations of  172 Male Skid Row Alcoholics Religion Number Percent Roman Catholic 81 47.1 Church of England 38 22.1 Lutheran 22 12.8 Presbyterian 19 11.0 Other* 6 3.5 None 6 3.5 Total 172 100.0 * This group includes: Greek Orthodox, Russian Orthodox, Baptist, Seven Day Adventist and Salvation Army. 1 Kelly, Alcoholism and Social Experience, p. 64. 2 Feeney, F.E. Mindlin, D.F,, Miniar, V.H., Short, E., "The Challenge of the Skid Row Alcoholic", Quarterly Journal of  Studies on Alcohol. Vol. 16, No. 4, Dec. 1955, pp. 645-667. It i s often said that many individuals l i v i n g on skid row are immigrants who have been unable to adjust to the Canadian culture. Table 5 makes i t clear that the majority were born i n Canada. In view of t h i s i t can be said that there are factors inherent i n the s o c i a l structure of t h i s country which are, i n part, responsible for these men becoming s o c i a l deviants. This would appear to contradict the previously expressed interpretation as to the effect of a foreign culture. In fact, i t does not. Table 5. B i r t h Place of 160 Male Skid  Row Alcoholics* Country of B r i t h Number Percentage Canada 115 72.0 Other 45 28.0 Totals 160 100.0 * B i r t h place of 12 men was not given. Table 6 shows the length of residence i n Canada of those men who were born i n another country. The significance of b i r t h place and length of residence i n r e l a t i o n to the adaptive patterns of these men i s two-fold. Of the 45 men who were not born i n Canada the majority have l i v e d i n this country f o r t h i r t y years or more. Since the mean age for the t o t a l group i s 46 years i t follows that many came to Canada i n childhood or adolescence. The displacement from one - 34 -culture to another at t h i s time combined with other negative factors (e.g. deprived home l i f e , poverty, psychological factors) could account f o r the assumption of a "retreatism" form of behaviour, eventually leading to alcoholism and skid row. It should be emphasized that s o c i a l or c u l t u r a l factors i n themselves cannot be held e n t i r e l y responsible for the kind of adjustment made, since many immigrants were i n a sim i l a r p osition and able to adapt successfully. Table 6. Length of Residence i n Canada of  45 Male Skid Row Alcoholics Number of Years i n Canada Number Percentage 1-5 2 4.4 5-9 0 — 10-19 2 4.4 20-29 3 6.7 30-39 24 53.3 40 and over 14 31.2 Totals 45 100.0 A second explanation helps to account f o r the poor adjustment of Canadian-born skid row alcoholics who have foreign-born parents. I t i s outlined by Straus who says, A large number of homeless men, however, are second-generation Americans;... The presence of many second-generation Americans among the homeless i s s i g n i f i c a n t when i t i s considered i n the l i g h t of innumerable studies which show that the incidence of s o c i a l disorganization i s f a r greater among second-generation than among first-generation Americans, A p a r t i a l explanation ofothis l i e s i n the c o n f l i c t i n g sets of mores between the foreign-born parents and t h e i r children, who were born and raised i n America. It has a l -ready been pointed out that many of the homeless men come from unstable homes; and one source of this i n s t a b i l i t y i s to be found i n a c o n f l i c t of mores.1 Since the group of homeless men that Straus studied were also alcoholics, then the same reasoning can be applied to the group under consideration here. The influence of s o c i a l change and c o n f l i c t i n g value systems probably i s a major determining factor i n the " r e t r e a t i s t " behavior shown by these men. More-over, i t i s c o n f l i c t between culture goals and i n s t i t u t i o n a l i z e d means i n the Canadian culture that helps to determine the type of person who w i l l choose this type of adaptive pattern. The c o n f l i c t would be f e l t mostly by those who have low status (are members of a lower c l a s s ) , and who would be least able to make legitimate use of the i n s t i t u t i o n a l i z e d means to achieve success. The frustrations inherent i n the class structure would be more intense f o r the person who i s an immigrant of low socio-economic status. In summary then, the c o n f l i c t s within our culture combined with those r e s u l t i n g from cross-cultural differences were overwhelming to many of the subjects so that they chose retreatism as an adaptation. Education In our society, educational attainment i s often used as a gauge of a person's prestige and status. Education i s 1 Straus, "Alcoholism and the Homeless Man", p. 384. - 36 -seen i n many instances as an end i n i t s e l f , but generally i t i s said that the higher the educational l e v e l , the better the person i s prepared for l i f e . We know that generally the skid row alcoholic i s ill-prepared f o r l i f e and i t i s reflected i n his educational achievements. What Straus c a l l s the " f a i l u r e to follow through" i s a s t r i k i n g c h a r a c t e r i s t i c of t h i s group. 1 Table 7 gives the education l e v e l of 172 male skid row alcoholics and i t i s noticeable that nearly 60 per cent l e f t school during Grades VI to VIII. And of those who went on to high school, the majority never completed Grade XII. With regard to the women i n the sample, none of them went beyond Grade X. Table 7. Educational Attainment of  172 Skid Row Alcoholics Education (Grades) Number Percentage None 1 .5 1-5 23 13.5 6- 8 102 59.3 7- 12 40 23.2 University 6 3.5 Totals 172 100.0 The average number of years of schooling f o r 165 males (excluding one who had no schooling and s i x who went to university) i s 7.5 years. Hence, the average skid row al c o h o l i c 1 Straus, "Alcoholism and the Homeless Man", p. 387. did not make very extensive use of i n s t i t u t i o n a l i z e d educa-t i o n . This, i n i t s e l f , i s not s i g n i f i c a n t unless i t can be shown that even as early as adolescence the i n d i v i d u a l showed signs of withdrawing from the demands and competition of the school system. As Straus points out, interrupted schooling could be due as well to such factors as poverty and family disorg a n i z a t i o n . 1 Nonetheless, the very lack of schooling would make success i n other areas d i f f i c u l t to achieve, lead-ing to further f a i l u r e and f r u s t r a t i o n . In order to r e l i e v e such feelings, the i n d i v i d u a l may use i l l e g i t i m a t e means of seeking s a t i s f a c t i o n (e.g. delinquency), or where t h i s involves too much anxiety, then some form of "retreatism" might be chosen as the primary adaptive pattern. Thus, f o r some, leaving school i s an escape from the frustrations of academic competition, and alcohol may serve as a means of blunting the f e e l i n g of f a i l u r e . A concept which i s helpful i n enlarging our under-standing of the alcoholic's f a i l u r e to "make good" i s one 2 introduced by Kurt lewin. He stated that a person's'level of aspiration" i s a measure of his conception of himself (self-image) as he i s and as he would l i k e to be. Hence, fo r the well adjusted person, the l e v e l of aspiration i s a func-t i o n of his r e a l i s t i c assessment of his capacities, his need 1 Straus, "Alcoholism and the Homeless Man", p. 389. 2 Stagner, R., Psychology of Personality, McGraw-Hill, 2nd ed., 1948, p. 293. - 38 -to improve and to avoid f a i l u r e . His l e v e l of aspiration would then be i n keeping with what i s r e a l i s t i c f o r him. In the maladjusted person one or more of the factors may be distorted, r e s u l t i n g i n a distorted l e v e l of aspiration. It may be presumed that the skid row alco h o l i c has a poor conception of himself, u n r e a l i s t i c expectations and an exaggerated fear of f a i l u r e . The destructive qu a l i t y of his l e v e l of aspiration i s then evident as his u n r e a l i s t i c expecta-tions are certa i n to be unattainable (due to psychological or s o c i a l factors) and hence lead to f a i l u r e , confirming his deep sense of worthiessness. This self-destructive mechanism i s reinforced by the emphasis upon the "success goal" i n our culture. Stagner suggests much the same thing when he says that a person's l e v e l of aspiration i s determined not only by his own conceptions of himself, but also by the values and standards of the group with which the individual compares himself. 1 In our society the in d i v i d u a l i s urged to compete against " a l l others" i n achieving the goal of success. Accordingly, we can say that the skid row alcoholic has given up s t r i v i n g to f u l f i l l his aspiration rather than experience once more the f a i l u r e to reach the i d e a l he has set for him-s e l f . The use of alcohol serves both purposes; i t allows him to escape from the painful r e a l i t i e s of l i f e and reach his ideals i n phantasy, while d u l l i n g his sense of inadequacy 1 Stagner, Psychology of Personality, p. 179. - 39 -and worthlessness. The self-defeating quality of thi s behaviour re s u l t s because even alcohol cannot completely remove the feelings of inadequacy, which are reinforced by s o c i a l condemnation. The skid row a l c o h o l i c 1 s poor opinion of himself and his awareness of s o c i a l condemnation i s consicely noted by Sara Harris as a r e f l e c t i o n of a conversation with one of these men. Only two ideas came out of our t a l k . He was r e a l l y nobody so why should he pretend, who was going to believe him anyway?l For the skid row alco h o l i c , there i s no need f o r a high l e v e l of aspiration as long as he i s on skid row, since his fellow "rowers" have few expectations of him. There i s no question of adequacy or achievement and few demands are made of him. 2 Jackson and Connor indicate the importance of group acceptance and suggest that i t can be a serious obstacle to r e h a b i l i t a -t i o n since i t i s often easier for the alcoholic to remain within the protective cover of the skid row group than to t r y readjusting to normal s o c i a l l i v i n g . The following i s t h e i r explanation of the group's importance to the al c o h o l i c . The group's unqualified acceptance, as compared to acceptance i n a non-Skid Road group, and i t s function i n helping the alcoh o l i c to escape feelings of i n -adequacy for a time, are recognized by 1 Harris, Skid Row. U.S.A., p. 31. 2 Jackson, Connor, "The Skid Row Alcoholic", p. 317. - 40 -some alc o h o l i c s . The informants agreed that 'Skid Road' drew them because there they could s t i l l act as 'big shots' when they could no longer do so elsewhere. As t h e i r drinking progressed they became less and les s accepted as 'big shots' i n t h e i r own class groups. Stories of self-importance came to be challenged i n the face of a poverty of deeds to support the claims. Unable to accept themselves as 'ordinary' they descended a notch on the s o c i a l scale to find a new group which could be impressed both by t h e i r s t o r i e s and by t h e i r higher s o c i a l status. Gradually t h i s group, too, rejected them, and they moved down again. Ultimately, they reached Skid Road. Here no one asked questions or demanded per-formance to back t h e i r claims. Their boast-f u l tales were no longer subject to the re s t r a i n t s of l i s t e n e r skepticism, and they were elaborated upon eonsiderably.l Hence, the skid row drunk i s able to r a t i o n a l i z e his f a i l u r e s and substitute words for deeds. The man who spends his time on skid row i n t h i s atmosphere of unqualified "acceptance" w i l l undoubtedly have a distorted perception of himself and society, f a i l i n g to take into account his a b i l i t i e s and the external barriers which prevent him from f u l f i l l i n g his aspirations. I t i s suggested then, that continued d i s t o r t i o n of the individuals l e v e l of aspiration (from the e a r l i e r stages of s o c i a l functioning) may be s i g n i f i c a n t i n understand-ing the deviant behavior of the skid row a l c o h o l i c . Occupation One of the major c r i t e r i a of s o c i a l status and class designation i s the type of work a person does. Generally, 1 Jackson, Connor, "The Skid Row Alcoholic", p. 316. - 41 -the best-paying occupations have the highest prestige value, although there are exceptions to t h i s (e.g. m i n i s t e r i a l work). Not only t h i s , but work i n i t s e l f (regardless of the type of work) i s valued highly, and the unemployed person i s seen as a non-productive member of society. "For t h i s reason and f o r other l e s s obvious reasons, work per se, has a high value i n our culture. But the skid row alcoholic i s a deviant i n both ways; he i s usually unemployed and he does not value work except as a means of obtaining money for alcohol. Hence, i n t h i s area too he has withdrawn emotional involvement from the goals and i n s t i t u t i o n a l means which the culture sees as desirable. Table 8 gives the occupational status of 172 male skid row alcoholics showing that the majority are u n s k i l l e d . Table 8. Occupational Status of 172 Male  Skid Row Alcoholics Occupational Status* Number Percentage Group I - -Group II 4 2.3 Group III 14 8.1 Group IV 151 87.8 Group V 3 1.8 Totals 172 100.0 * Group I - professional, managerial and proprietary; Group II - white c o l l a r (salesmen); Group III - s k i l l e d and semi-skilled (carpenter, wall-presser, baker, signalman, sawyer, cat skinner, t a x i driver, cook, painter, sheet metal worker, pipe f i t t e r ) ; Group IV - unskilled (laborer, logger, miner, seaman, fisherman, longshoreman, farmhand); Group V -other (pensioner, j a i l " t r u s t y " ) . - 42 -Table 9 gives the employment status of the same group at the time of a r r e s t . It i s s i g n i f i c a n t to note that of the 151 unskilled workers, 112 gave the i r occupation as laborer and another 24 l i s t e d themselves as loggers. Table 9. Employment Status of 172 Male Skid Row Alcoholics at the Time of Arrest Employment Status Number Percentage Unemployed 166 96.5 Employed 6 3.5 Totals 172 100.0 Although data were not given f o r work history, i t can be assumed on the basis of other studies, that the majority of the men i n the sample would have had i r r e g u l a r and sporadic work records since reaching skid row. The low value which work has for the skid row alcoholic i s i n con-tr a s t to i t s value for the "hidden" or "respectable" a l c o h o l i c . With the l a t t e r , work i s s t i l l regarded as necessary and t h i s b e l i e f r e f l e c t s his need to l i v e within the mores and norms of the culture. But, when the "hidden" alcoholic finds he i s unable to hold a job f o r any length of time because of his alcoholism, then he i s on the way down. For he would gradually f i n d himself i n a position where the only type of work he could get i s that which i s c l a s s i f i e d as a low occupa-t i o n a l category (e.g. laborer, casual work). This i n turn - 43 -would tend to increase feelings of inadequacy and also his need f o r alcohol to blunt these f e e l i n g s . This "vicious c i r c l e " aspect of the alcoholic's l i f e may drive him to skid row where he can escape the anxiety and fear through a con-t i n u a l state of intoxication. Marital Status Marriage and family l i v i n g are considered the "corner-stone" of our society and i t i s i n t h i s area of l i v i n g that the closest of relationships between people are required. As Straus points out, marriage not only gives sanction to expression of the sexual drive, but i s also a vehicle f o r p a r t i c i p a t i o n i n a number of other s o c i a l i n s t i t u t i o n s (e.g. church, recreation, school).)1 The skid row alcoholic shows both an i n a b i l i t y to sustain close relationships with others and a disregard for the value of marriage and family l i v i n g . Table 10 shows the d i s t r i b u -t i o n of marital status for 172 male skid row a l c o h o l i c s . Table 10. Marital Status of 172 Male Skid Row Alcoholics Marital Status Number Percentage Single 135 78.5 Married 4 2.3 Separated 25 14.5 Divorced 5 3.0 Widowed 3 1.7 Totals 172 100.0 1 Straus, "Alcoholism and the Homeless Man", p. 374. - 44 -It i s s i g n i f i c a n t that only four of these men are s t i l l l i v i n g with t h e i r wives and can be considered married i n the true sense of the word. Although there i s reason to believe that some of the men gave t h e i r status as single when i n fact they had been married at sometime, the above figures give the r e l a t i v e d i s t r i b u t i o n and are consistent with Straus 1 f i n d i n g s . 1 Moreover, the fact that some men who have been married con-sider themselves as single i s suggestive of t h e i r wish to forget or disregard past experiences. The deviance from the normal population with regard to marriage ( p a r t i c u l a r l y when other aspects of functioning are considered) further confirms that the skid row alcoholic " i s i n society, but p not of i t . " Considering those who reported having been married, i t i s s t r i k i n g to note that 81 per cent were not able to achieve success i n marriage. The psychological significance of these data should not be overlooked, for as Myerson says, This s t r i k i n g f a i l u r e i n t h e i r interpersonal relationships needs special emphasis because of the important role i t plays i n understand-ing t h e i r isolated l i v e s and the set-up of any r e h a b i l i t a t i o n program for them.3 1 Straus, "Alcoholism and the Homeless Man", p. 377. 2 Merton, S o c i a l Theory and Soc i a l Structure, p. 153. 3 Myerson, D.J., "Further Observations of a Group of Skid Row Alcoholics", Institute on the Skid Row Alcoholic, Thurs., March 29, 1956, p. 1. - 45 -This p a r t i c u l a r short-coming i s , according to the same author, common to a l l these men. Whatever the diagnostic category, these men showed unusually repressed and primitive relationships.... This relationship was a simple one i n which they were interested only i n those individuals who gave them t h e i r supplies whether alcohol or money.1 It i s not surprising then that the majority of skid row alcoholics remained si n g l e . It would seem that they were made conscious, by t h e i r l i f e experiences, of the dangers (for them) of entering into a close relationship such as i s demanded i n marriage. The key factor i n t h i s shortcoming i s the alcoholic's i n a b i l i t y to "give" to another person. The alcoholic functions at such a s o c i a l l y immature l e v e l that he cannot trust another person, because he i s so deprived himself. The i n a b i l i t y to give and constant demanding from the marital partner i s certain to cause severe s t r a i n on the marriage i t s e l f . As Sara Harris points out, the skid row alcoholic's deep insecurity i n any r e l a -tionship causes him to hurt those he "loves" so they cannot 2 hurt him. The defense i s obviously self-defeating, r e s u l t -ing i n the break-down of the marriage and the aggravation of the alcoholic's r e t r e a t i s t behavior. He becomes increasingly demanding and i s unable to trust others. 1 Myerson, "Further Observations of a Group of Skid Row Alcoholics", p. 7. 2 Harris, Skid Row U.S.A., p. 31. - 46 -The poverty of the skid row alcoholic's i n t e r -personal relationships i s further emphasized upon investiga-t i o n of data pertaining to next of k i n . Table 11 gives the number of men who reported having next of kin, and i t i s si g n i f i c a n t to note that over 50 per cent said they had none. Table 11. Next of Kin as Reported by 172  Male Skid Row Alcoholics Next of Kin Number Percentage None 94 54.7 Relative* 61 35.5 Wife 14 8.1 Not^given 3 1.7 Totals 172 100.0 * Includes mother, father, s i b l i n g s and children. For those who reported next of kin, the residences of these people are given i n Table 12. It i s obvious then that the Table 12. Place of Residence of Next of Kin as Reported by 75 Male Skid Row Alcoholics Place of Residence Number Percentage Vancouver 11 14.7 B r i t i s h Columbia 24 32.0 Canada 30 40.0 Foreign Country 8 10.7 Not Given 2 2.6 Totals 75 100.0 - 47 -large majority of skid row drunks are isolated, both from their families of orientation and procreation. Only 14 of the 172 men reported dependents, despite the fact that 37 had been married at one time or another. This loss of contact is probably due to the fact that their families do not wish to associate with them, and partly because the men themselves do not want their families to know the extent of their degradation. Number of Arrests Further evidence of the extent of retreatism as found in skid row alcoholics is seen upon investigation of the arrest frequencies among this group. More than any other measure i t i l lustrates sharply the disregard these individuals show for the sanctions of society. The skid row alcoholic fears imprisonment, not because i t is a reflection of social condemnation, but because i t deprives him of the alcohol he craves. According to several police officers at the Vancouver City J a i l , the skid row drunk prefers a one month j a i l sentence to a five day sentence (as is often given), because in five days he just gets over the painful withdrawal from alcohol then is released. Immediately he goes in search of l iquor. With a 30-day sentence he has an opportunity to "dry out", build up his body and get some needed rest before going back to the row. The adequacy of either type of sentence w i l l be dealt with - 48 -i n a l a t e r section. The c r i t e r i o n of not less than f i v e arrests i n the year I960 was selected so that i t would be safe to assume that the study i s dealing with the true skid row a l c o h o l i c . Figure 1 shows the number of arrests which t h i s group accounted f o r i n I960. The average number of arrests per man for that year was 7.5 and the 172 males accounted f o r a t o t a l of 1278 arrests i n I960 - or 11 per cent of the t o t a l number of arrests for drunkenness i n I960. Figure 1. Arrest Frequency of 172 Male  Skid Row Alcoholics - 1960 I 45 S 40 I 35 I 30 D 25 A 2 0 L 15 C 10 A 5 S 3 E S 5 6 7 8 9 10 11 12 13 14 Number of Arrests for Each Case As a further i n d i c a t i o n of the s o c i a l l y deviant be-havior of these men, Table 13 shows the arrest records for varying periods. - 49 -Table 13. Longitudinal Arrest Records of  172 Male Skid Row Alcoholics* Period (In Years) Number Total Number of of Cases Arrests for Period Given 1956- 1960 126 4952 1957- 1960 18 380 1958- 1960 7 130 1959- 1960 15 181 I960 6 48 Totals 172 5491 * The time periods, cases and number of arrests are exclusive for each class interval . Por example, the cases and number of arrests included in the period 1957-1960 are not included in the period 1956-1960. The purpose of the table is to i l lustrate how many men have long records of arrests for drunkenness in Vancouver. The 126 men with an arrest record of at least five years, represents 73*3 per cent of the sample, and are the "hard-core" skid row alcoholic group, having compiled nearly 5000 arrests between them. This is an average of 39 arrests per man in five years or eight arrests per year. The remain-ing 46 men have arrest records (in Vancouver) varying from one to four years and probably represent newer additions to the row or men who have migrated from a skid row in another c i ty or part of the country. With regard to the female portion of the sample, the twelve women had amassed 596 arrests between them since 1956. Thus, the total for 184 persons during those five years was over 6,000 arrests. The cost of this can only be guessed at but the tragic part is that perhaps a l l of them are s t i l l on skid row and neither - 50 -they nor the community have received any benefits from the time, money and e f f o r t spent. Conclusion In t h i s chapter an attempt has been made to demonstrate the ways i n which the skid row a l c o h o l i c has, i n fact, retreat-ed from society. Summarizing the data presented, i t i s certain that most of his behavior (past and present) i s marked by withdrawal from normal s o c i a l l i v i n g through the use of alcohol. It i s possible on the basis of the facts which have been presented i n t h i s chapter to describe ret r e a t -ism as a "state", a phenomenon which exists at a p a r t i c u l a r point i n time. But, i t i s important to make a d i s t i n c t i o n between retreatism as a "state" and retreatism as a "process." Merton does not make i t clear as to the significance of the concept i n describing behavior and a continuing basis and longitudinal study i s needed so as to evaluate whether or not i t adds to our understanding of why individuals become skid row alcoholics (that i s , r e t r e a t i s t s ) . For, while i t i s important to know that people do retreat or withdraw from "normal" patterns of s o c i a l functioning, t h i s i s not a substitute f o r determining causal factors. This study, while consistent with the former i s only suggestive of e i t i o l o g y , and then only through hypothesis. On the basis of the material presented i n t h i s chapter, i t i s possible to form a personal and s o c i a l picture - 51 -of the t y p i c a l or average skid row alcoholic who l i v e s ; i n Vancouver. He i s about 45 years of age and i s of I r i s h . Scottish or Native Indian descent, but seldom Oriental or Jewish (very l i k e l y never the l a t t e r ) ; he i s Roman Catholic or Protestant; he was born i n Canada, but i f he i s an immigrant, he has been here for more than t h i r t y years; his education was interrupted before he completed Grade VIII; he i s an unski l l e d laborer who i s unemployed and he has l i t t l e chance of obtaining or desire to obtain permanent employment; he i s single (or considers himself as such) and i f he was formerly married, he i s separated from his wife; he has no next of kin (and those who have are not i n close contact with them); and he has had a great deal of contact with the law enforcement agencies, having been arrested for drunkenness at least seven times i n any given year since 1956. The structure of the skid row alcoholic's personality ( i n a b i l i t y to "give", poor perception of r e a l i t y , mistrust of others, and a deep sense of worthlessness) would seem to make him a poor candidate for r e h a b i l i t a t i o n . But before affirming or denying t h i s observation, i t i s necessary to ask certain questions. What i s his background and how long has this process of deterioration taken? What pa r t i c u l a r aspects of his family, school and s o c i a l l i f e are of s i g n i f -icance i n understanding the etiology of his condition? What treatment f a c i l i t i e s are available i n t h i s c i t y for helping - 52 -him? What purpose does repeated arrest and j a i l i n g serve? How successful have been the attempts to treat him? And i f they have been unsuccessful, i s t h i s due to poor motivation, a deficient treatment program, both, or something else? Can the community a l t e r i t s attitudes toward the skid row alcohol-i c and help him to adjust to the normal demands of the culture? Are these demands excessive or not conducive to normal adjustment? The attempts to answer these questions should give some insight into the needs of thi s group of s o c i a l deviants. In t h i s chapter then, the main characteristics and present functioning of the skid row alcoholic have been ex-plored. In Chapter I I I , a survey of the treatment f a c i l i t i e s and s o c i a l resources available to the skid row alco h o l i c w i l l be made, along with an evaluation of t h e i r effectiveness. In this way, i t i s thought to answer some of the questions which aris e as a result of the data presented. Only then can we determine i f the l o c a l community has made a serious attempt to deal with the problem. CHAPTER III TREATMENT FACILITIES AND RESOURCES In the previous chapter an analysis of the charac-t e r i s t i c s of the skid row alcoholic pointed to his extreme i s o l a t i o n from the rest of the community. Since the nature of his i l l n e s s implies d i f f i c u l t y i n mobilizing personality resources, he must, at least i n the acute phase, be almost wholly dependent upon others for treatment. 1 The findings of the study show that his contact with family or re l a t i v e s i s v i r t u a l l y non-existent so that some resource beyond that i s required i f he i s to be aided. The purpose of the present chapter i s to examine the resources available to the skid row alc o h o l i c . Generally, these may be classed as medical, psychiatric and s o c i a l , with pa r t i c u l a r focus on those a v a i l -able i n the Vancouver area. A detailed analysis i s beyond the scope of t h i s project, but even a limited study w i l l provide some insight into the extent and adequacy of the services available. Medical When r e f e r r i n g to medical treatment t h i s i s limited to the means by which the physical symptoms of acute and 1 Myerson, "A Three Year Study of a Group of Skid Row Alcoholics", p. 153. - 5 4 -chronic alcoholism may be relieved. Such symptoms as delirium tremens, blackouts, malnutrition, l i v e r disorders, loss of appetite and sleep cause extreme discomfort to the alcoholic and must be treated p r i o r to involving the i n d i -v i dual i n a prolonged therapeutic program."1* Psychological symptoms such as i r r i t a b i l i t y , tension, depression, aggressiveness, are often reduced when the acute physical symptoms have been treated. Several drugs have found to be h e l p f u l i n t r e a t i n g acute symptoms. The use of chlorpromazine to r e l i e v e the severe agit a t i o n of acute alcoholism intoxica-t i o n i s reported and the conclusion drawn that i t i s helpful p as an aid to treating post i n t o x i c a t i o n symptoms. Experi-ments have been conducted with ACTH (adrenocorticotropic hormone) and i t has been found to be a valuable aid i n the treatment of alcoholic psychoses. Reserpin has also been used and found to be e f f e c t i v e , without severe side effects, and i t shortens the time necessary to free patients of t h e i r post-alcoholic symptoms, making nursing care less d i f f i c u l t . ^ 1 Bailey, M.B. and Puchs, E., "Alcoholism and the Social Worker", S o c i a l Work. Vol. 5 , No.4, Oct. I960, p. 18. 2 Alcoholism Review. "Calming the Agitated Alcoholic with Chlorpromazine", Vol. 1, No. 2, Aug. 1955, pp. 5-7. 3 Kant, F., The Treatment of the Alcoholic. 1954, p. 66. 4 Avol, M. and Vogel, P.J., "A New Treatment f o r Delirium Tremens", Alcoholism: Basic Aspects and Treatment, AAAS, 1957, pp. 115-123. - 55 -Meprobamate i s useful i n r e l i e v i n g the sub-acute symptoms (restlessness and insomnia) of alcohol withdrawal. 1 Massive doses of vitamins are also used during early h o s p i t a l i z a t i o n since the alcoholic i s usually deprived of these during his excessive drinking periods. The use of drugs i n order to produce long-term abstinence from alcohol has also been reported. Emetine has been reported as being successful i n inducing abstinence for lengthy periods of time and i n one study s i x t y percent were able to abstain from excessive use of alcohol f o r at least 2 a period of one year. Another study reports that 51 f i f t y -one per cent of f i v e hundred patients remained abstinent f o r a year a f t e r treatment with apomorphine. Antabuse (disulfiram) i s one of the newest drugs i n use and has been found e f f e c t i v e i n aiding the alcoholic to remain abstinent. 1 In regard to this and other "aversion" drugs, Noyes and Kolb emphasize that: For the treatment to be successful, how-ever, i t i s necessary f o r the patient to have a r e a l desire to be helped, to be w i l l i n g to take the drug with consistency and to co-operate i n psychotherapy.5 1 Thimann, J . , "Newer Drugs i n Treatment of Acute Alcohol-ism with Special Consideration of Meprobamate", op. c i t . p.5. 2 Alcoholism Review, "Comparing Treatments for Alcoholism", V o l . 1, No. 1, A p r i l 1955, p. 11. 3 Ibid., p. 11. 4 Alcoholism Review, "How Disulfiram Helps i n the Treat-ment of Alcoholism", Vol. 1, No. 2, Aug. 1955, p. 10. 5 Noyes, A.P. and Kolb, L.C. Modern C l i n i c a l Psychiatry, Saunders, 1958, Chapter X, p. 2101 - 56 -Unfortunately, most skid row alcoholics do not have this degree of motivation. The above methods (along with proper d i e t , regular routine and physical therapy) are important i n helping the a l c o h o l i c to achieve physical and mental s t a b i l i t y while i n h o s p i t a l . Upon reaching t h i s l e v e l he i s usually released from hospital and being l e f t to his own resources he i s quick to return to his former pattern of functioning. Psychiatric Although a few skid row alcoholics may make use of psychiatric treatment available i n the community, i t i s the writer's opinion that these represent a very small percent-age of the t o t a l . This i s due to the fact that few of the individuals apply v o l u n t a r i l y f o r such service and also because of the view that "he seems p a r t i c u l a r l y resistant to therapy i n any form." 1 Hence, psychiatric treatment i s l a r g e l y limited to that which the individual receives when he i s admitted to the P r o v i n c i a l Mental Hospital at Essondale. There are approximately 300 admissions for alcoholism to the Centre Lawn building of that hospital per year. Of these, approximately fo r t y percent could be c l a s s i f i e d as skid row a l c o h o l i c s . 1 Alcoholism Review, "The Challenge of the Skid Row Alcoholic", Vol. 1, No. 5, Aug. 1956, p. 6. - 57 -Upon admission, the patient i s generally treated with chlorpromazine and vitamins, and within a few days i s usually well enough physically to be placed on a predischarge ward. The usual length of stay i s t h i r t y days and during t h i s time he i s on a ward with other alcoholics and improved psychotic patients. He i s required to attend group meetings i n which the p s y c h i a t r i s t acts as catalyst to encourage free discussion of drinking and other problems. He i s also encouraged to attend Alcoholics Anonymous meetings which are held i n the evenings, as well as view films dealing with alcoholism. Added to these i s the general milieu of the ward and hospital through which the alcoholic has an opportunity to view him-s e l f and his problems i n a new way. I f a s t a f f member feels that a p a r t i c u l a r alcoholic i s "well motivated" the doctor may begin t h i s person on antabuse therapy and r e f e r him for psychotherapy upon discharge. The majority of alcoholics are diagnosed as "Socio-pathic Personality Disturbance Associated with Alcoholism Addiction" and t h i s " l a b e l " i s usually s u f f i c i e n t i n i t s e l f to discourage prolonged treatment since, to the majority of psy c h i a t r i s t s , i t indicates a very poor prognosis. Thus, the alcoholic i s released from hospital i n an improved physical and mental condition but i s no closer to a resolu-t i o n of his drinking problem. This i s evidenced by the fact that the recidivism rate i s high (estimated at f o r t y to f i f t y per cent). When thi s i s considered against the fact that i t - 58 -eosts the public over seven dollars per day f o r each patient i n the P r o v i n c i a l Mental Hospital (a conservative estimate for the care of alcoholics i n t h i s i n s t i t u t i o n would be s i x t y thousand do l l a r s per year) i t would seem that a thorough study of the problem would be f a r less expensive and produce better results i n the long run. S o c i a l workers on s t a f f at the P r o v i n c i a l Mental Hospital are normally involved i n a limited way with the a l c o h o l i c . P r i o r to his discharge from the h o s p i t a l , the alcoholic i s seen by a s o c i a l worker who makes an assessment of the individual's immediate needs. He may then recommend that a "gratuity" ( i n an amount up to a twenty d o l l a r maximum) be given. He may also suggest that the alcoholic be provided with clothing and i n many cases w i l l write a l e t t e r of r e f e r r a l (for f i n a n c i a l aid) to the C i t y Social Service Department i n Vancouver or to the Department of S o c i a l Welfare elsewhere i n B r i t i s h Columbia. In some cases intensive case-work services are offered but these are generally limited to those alcoholics who are returning to t h e i r families so that, as i n psychiatric therapy, the skid row alcoholic i s excluded. This concurs with the results of a study by Bailey and Puchs who found that only 22 per cent of t h e i r respondents ( s o c i a l workers) rated casework as an e f f e c t i v e method for treating alcoholics." 1" This figure would probably be much lower i f 1 Bailey and Fuchs,"Alcoholism and the Social Worker,"p.18. skid row alcoholics only were considered. As noted previously, the skid row alcoholic's personal and family resources are almost non-existent and hence he i s l a r g e l y dependent upon s o c i a l agencies for s a t i s f a c t i o n of many of his needs. Thus, an examination of the type of service given hy several agencies i n Vancouver should serve to evaluate the extent to which the public recognizes the problem. Tossome degree the effectiveness of these services i s also a measure of the skid row alcoholic's a b i l i t y to make use of s o c i a l resources. F i n a n c i a l Aid As i s indicated by the results noted i n Chapter II, the skid row alcoholic has a poor employment potential and i s unemployed most of the time. For t h i s reason he does not have a s o c i a l l y acceptable means of obtaining money to support himself and his addiction. He must then f i n d other means of doing so. This i s usually accomplished by applying for s o c i a l assistance at the Vancouver City S o c i a l Service Department since i t i s the agency nearest skid row able to supply him with funds. As the main c r i t e r i o n f or receiving f i n a n c i a l aid i s that the person be destitute, or very close to i t , the skid row alcoholic undoubtedly q u a l i f i e s to receive $66 per month. In order to save as much of thi s money as possible f o r drinking, i t i s necessary to keep other expenses at a minimum, and t h i s usually involves sleeping i n a "flop house" - 60 -(or in a back a l ley) , obtaining meals (one a day or less) from a mission and perhaps getting clothing from the Salvation Army or similar resource. When out of money he may join a group of other alcoholics for the purpose of pooling resources in order to obtain more l i q u o r . 1 In an attempt to prevent the misuse of public funds by the skid row alcoholic, cash grants are kept to a minimum by having the alcoholic's social assistance administered by a responsible member of the community (often a priest , minister, or staff member of a mission). This person pays the alcoholic's room rent, buys his clothing and supplies him with meal t ickets . This can be done in only a few cases since i t requires the "administrator" to make a heavy invest-ment of time and effort. This increases the alcoholic's dependency and appears to have l i t t l e effect in controlling his drinking. A more usual method takes the form of issuing the bulk of the grant in the form of "vouchers" for rent, clothing and food. In the writer's personal experience, i t is not unusual then for the alcoholic to s e l l these vouchers for less than half the face value and in this way have cash with which to buy l iquor. To a person who is so dependent upon alcohol, this type of deterrent is mostly ineffective, 1 An interesting and informative study of group formations among skid row alcoholics is provided by Jackson and Connors, "The Skid Row Alcoholic", Drinking and Intoxication - selected readings in Social Attitudes and Controls. Ed. McCarthy, R . G . , 1959, pp. 319-320. - 61 -f o r as Myerson points out: "...to get money for alcohol they would beg, borrow or s t e a l without qualm and even a once devout church goer stole from the poor box." 1 Further, many s o c i a l workers object to such methods on the basis of t h i s being an extreme r e s t r i c t i o n of the individual's " s e l f -determination." It tends to emphasize to the a l c o h o l i c that he i s a s o c i a l m i s f i t and a parasite, unfortunately r e i n -forcing his propensity to remain as such. The poor motivation of the skid row alcoholic precludes such r e s t r i c t i v e methods as i t encourages him to devise more ingenious ways of obtain-ing alcohol. As most skid row residents are required to pick up t h e i r s o c i a l assistance grants i n person, "pay day" at the City Social Service Department has a l l the appearance of a "soup l i n e . " Seldom are casework services provided to the skid row a l c o h o l i c , r e f l e c t i n g i n part the pessimistic attitude of s o c i a l workers toward the problem of chronic alcoholism. Such negative attitudes without constructive substitutes w i l l only create further waste of human and economic resources. Employment In keeping with the facts of t h i s study i t i s true to say that the skid row alcoholic contributes nothing to 1 Myerson, D.J., "Further Observations of a Group of 'Skid Row* Alcoholics with Emphasis on Inter-personal Relationships and the Therapeutic Approach", Institute on the Skid Row  Alcoholic, 1956, p. 5. 2 Bailey and Fuchs, Alcoholism and the S o c i a l Worker, pp.14-19. - 62 -the society from which he i s i s o l a t e d . Most work only as a l a s t resort to obtain funds for alcohol. S t i l l , there i s not a sudden abandonment of the role of wage earner, but a gradual deterioration. This i s presented graphically by Myerson who reports: Many men maintained themselves by sporadic jobs f o r a long period of time, but ultimately l o s t t h e i r a b i l i t y to work and hence t h e i r a b i l i t y to earn money. This loss brought about t h e i r f i n a l separation from society and a complete isolation.1 From the writer's personal observations, the National Employment Service i s more loath to accept r e f e r r a l s of alcoholics than most other i l l n e s s or handicap categories (except perhaps where epilepsy and alcoholism are combined). While th i s i s understandable, i t has a damaging effect, for i t leads the alcoholic to give up any pretense of looking for work, although some express a vague idea of "finding a job" when they are well. In most cases, prolonged r e l i e f from his alcoholism i s necessary before the skid row alcoholic would be f i t to work, to be followed ( i n the beginning) by a highly structured work setting. A change i n the attitudes of employers i s also necessary i n that they have been prone to regard alcoholism as a lack of " w i l l power" rather than a disease requiring patience, perseverance 1 Myerson, Institute on the Skid Row Alcoholic, p. 5. and understanding. J e l l i n e k refers to the changing attitudes of employers, but cautions that "...the b e l i e f i n a disease conception does not go very deeply with the majority...."""" Missions and Shelters These agencies, whatever t h e i r shortcomings, appear to recognize that despite the s o c i a l and psychological state of the a l c o h o l i c , his immediate needs (food;* shelter, clothing) must be met. Resolution of the deep-rooted personality problems i s not t h e i r primary focus, but rather they t r y to control the alcoholic's drinking f i r s t . Whether t h e i r r e l i g i o u s focus acts as a motivation factor or a deterrent to the a l c o h o l i c , i s d i f f i c u l t to assess, as the missions are not given to evaluating t h e i r work i n a systematic or s c i e n t i f i c manner. Nevertheless, they are involved closely with these people and perhaps with increased aid from and coordination with other agencies, could provide the f i r s t step i n the r e h a b i l i t a t i o n of the a l c o h o l i c . The Police Court and the Prison These resources perhaps r e f l e c t most c l e a r l y the paucity of service available to the skid row alcoholic and also demonstrate that the problem i s increasing. In 1939 1 J e l l i n e k , E.M., The Disease Concept of Alcoholism, I960, p. 182. - 64 -the number of arrests f o r drunkenness totaled 2,421 i n the Ci t y of Vancouver. 1 In 1953 th i s figure rose to 8,860 (the cost of arresting and caring for these people was estimated p at $8.50 per capita per year). In I960, 11,525 arrests f o r drunkenness were made, representing a t o t a l cost of $28,837.50 f o r court procedures alone.^ Of this number, the study group of 184 persons accounted for 12 per cent of the t o t a l and approximately $3,500 i n court costs.^" The fact that a large number of those arrested are "hard core" skid row alcoholics strongly suggests the need for proper follow-up at the point of arrest. At the present time, the alc o h o l i c i s usually held overnight or given a term (usual 30 days) i n the Oakalla Prison Farm. Once released, he generally i s back on skid row within a short period of time and the cycle begins once more. Miss Harris emphasizes the need to stop t h i s "useless" 5 method. That this method i s widespread i s pointed out by 1 Court Clerks Office, Vancouver City J a i l , I960. 2 McRae, E.D. "The Alcoholism Foundation of B r i t i s h Columbia", Alcoholism Review, Vol. 1, No. 1, A p r i l , 1955, p. 4. 3 Court Clerks Office, Vancouver City J a i l , I960. 4 The number of arrests f o r drunkenness i n 1962 totaled 14,075. See the Vancouver Sun, Wed. Feb. 6, 1963, p. 6. 5 Harris, Skid Row U.S.A., pp. 201-285. Straus who refers to the fact that, . . . i n most communities the police f i e l d patrol force spend as much as ha l f t h e i r time i n handling drunks and by this token he rates alcoholism as the single most important law enforcement agency i n the country....1 Magistrate Hume has made the point that the cost of arresting, t r y i n g and keeping the alcoholic i n j a i l i s f a r out of o proportion to the public's return on i t s investment. In view of the above i t i s not surprising then that the author received a d i s t i n c t impression of hopelessness, pessimism and "what's the use" when talking to the o f f i c e r s and o f f i c i a l s who deal with the alcoholic i n the Vancouver City J a i l . A discussion of possible changes i n the present methods w i l l be presented i n Chapter IV. Alcoholics Anonymous In Vancouver, as i n numerous other areas i n North America there are many Alcoholics Anonymous groups. Their success i n the treatment of alcoholism i s generally accepted and supported by evidence from several studies. As th e i r main c r i t e r i a of membership are the wish to remain sober and the desire to help others achieve sobriety, many alcoholics 1 Marriage, The Police Court Drunkenness Offender,p. 32. 2 The Vancouver Sun. Wed. Feb. 6, 1963, p. 6. 3 For example, see Alcoholism Review. "Comparing Treat-ments for Alcoholism", Vol. 1, No. 1, A p r i l , 1955, p. 12. - 66 -find i t a more helpful resource than agencies which have a formal organization. The focus-is primarily upon alcoholism as such, and i t offers v i v i d proof that the problem can be controlled. Success i n treatment is l a r g e l y attributable to four main factors: unqualified acceptance of the alcoholic as a person i n need of help; providing hope of recovery; convincing the person to accept that he i s an a l c o h o l i c ; and, helping the individual to accept himself as a worthwhile human being. 1 As Kant points out, the key to success i s 2 unqualified acceptance of the a l c o h o l i c . In view of the above, i t could be suggested that Alcoholics Anonymous i s a resource to be used by the skid row alcoholic, but there are several factors which contra-indicate t h i s conclusion. F i r s t , as i s pointed out by an A.A. member: "The A.A. program works admirably fo r those who sincerely desire sobriety and who go along with the twelve suggested steps upon which they may safely rebuild t h e i r l i v e s . " This suggests the need fo r a high degree of motivation on the part of the alcoholic, and for this reason A.A. i s a resource for the "respectable" alcoholic, rather 1 Lee, J.P., "A.A. as a Community Resource", Social Work, Vol. 5, No. 4, Oct. 1960, pp. 20-26. 2 Kant, F., The Treatment of the Alcoholic. 1954, pp. 98-104. 3 Alcoholism Review. "The A.A. Way", Vol. 1, No. 3, Dec. 1955, p. 10. - 67 -than the skid row drunk. 1 The t y p i c a l A.A. members's "resources" are generally superior to those of the Skid Row a l c o h o l i c . This i s emphasizedfiby Noyes and Kolb who state: "As a rule, members of Alcoholics Anonymous are above the average i n i n t e l l i g e n c e , education and s o c i a l status and t h e i r 2 attitude toward the addict i s tolerant and constructive," A study of the characteristics of members of A.A. and non-members also indicates that the skid row alcoholic i s l i k e l y not to make use of t h i s resource. H.M. Trice found that non-members displayed the following c h a r a c t e r i s t i c s : more complete i s o l a t i o n than members; more subscription to the "will-power" idea; continued membership i n informal drinking groups; sponsorship to A.A. lacking; non-acceptance of the need to stop drinking; s o c i a l - c l a s s s e n s i t i v i t y ; unfavorable impression of A.A.; not as l i k e l y to regard alcoholism as an i l l n e s s . From our knowledge of the skid row alcoholic i t would appear that he i s most often among the non-member group. As Marriage contends, the A.A. must be considered as a resource which does not meet the needs of the skid row a l c o h o l i c . ^ 1 Harris, Skid Row U.S.A.. pp. 201-285. 2 Noyes and Kolb, Modern C l i n i c a l Psychiatry, p. 208. 3 Alcoholism Review, "Factors Influencing Success i n A f f i l i a t i o n with A.A.", Vol. 2, No. 2, Aug. 1957, p. 10. 4 Marriage, The Police Court Drunkenness Offender, p. 24. - 68 -The Br i t i sh Columbia Alcohol Foundation' This foundation was established in 1953 as a private agency (largely subsidized by grants from the Provincial Government) in response to the recognition of the special needs of the alcoholic. Its focus is four-fold: treatment of the acute and chronic phases of alcoholism; rehabil itation of the alcoholic intterms of family, employment and community reintegration; research into the problem of alcoholism; and, education of specific groups and the general public regarding the problem of alcoholism. The c l i n i c provides services primarily to the "respectable" alcoholic, that i s , the person who has a problem with alcohol but whose social functioning is s t i l l acceptable, even i f impaired. When the c l in ic f i r s t opened, i t was found that a large number of skid row alcoholics sought help there. This has diminished in recent years and is part ia l ly due to the fact that in the beginning, many wanted to "test" this new service. Thus, a large number involved themselves in a "one time" attempt at treatment, but because of the demands placed on them for co-operation and motivation, they soon severed the connection. The c l in i c i t s e l f does not encourage the referral of skid row alcoholics in the belief that a more specialized 1 Many of the ideas and much of the information contained in this section were the result of personal discussion with Mr. E.D. McRae, Executive Director of the B . C . A . F . Also, they resulted from his le t ter to the writer entitled "The Skid Row Alcoholic", A p r i l 12, 1963. - 69 -service i s required for this group. Also, the skid row drunk i s considered an extremely poor treatment r i s k and the c l i n i c does not have the funds to invest i n the treatment of an ind i v i d u a l where the prognosis i s very poor. The s t a f f are of the opinion that i t i s not a matter of r e h a b i l i t a t i o n for the skid row alco h o l i c , but rather one of " h a b i l i t a t i o n " , since most of these individuals have been functioning at a grossly d e f i c i e n t l e v e l most of t h e i r l i v e s . They believe that the skid row alcoholic's problems are too many and too severe to be dealt with i n a small c l i n i c , and that he requires prolonged r e s i d e n t i a l care, followed by out-patient care and r e h a b i l i t a t i o n . Since the Foundation provides a maximum of three weeks r e s i d e n t i a l care, this i s only s u f f i c i e n t time for the alcoholic to "dry out" before he becomes an out-patient. 1 In t h i s regard, the program i s s i m i l i a r to that of the Pr o v i n c i a l Mental Hospital (persons discharged from there become out-patients at the After Care C l i n i c i n Burnaby). It i s the view of the c l i n i c a l s t a f f that the skid row alcoholic's lack of motivation and his seeming i n a b i l i t y to become motivated, m i l i t a t e s against providing c l i n i c services to thi s i n d i v i d u a l . His chronic state of drunkenness makes i t v i r t u a l l y impossible for him to consider his s i t u a -t i o n i n a s u f f i c i e n t l y r e a l i s t i c way and to involve himself 1 Since 1963, the r e s i d e n t i a l care program has been d i s -continued. - 70 -i n the Foundation's counselling and r e h a b i l i t a t i o n program. The Foundation accepts the need for a program f o r the skid row alcoholic but emphasizes that i t i s not within i t s scope to provide such a program. In summary, thi s has been a discussion and survey of the more commonly accepted resources f o r the skid row alcoholic, on which he depends for sustenance and treatment. In most cases he i s tolerated, but seldom welcome i n any. It i s d i f f i c u l t to estimate the cost of supporting this group for which the community, i n return, receives nothing. A positive, even i f more costly approach, i s necessary. This i s p a r t i c u l a r l y v a l i d when consideration i s given how much money i s spent on treatment of alcoholics i n r e l a t i o n to that spent on other, less urgent projects. The suffering, both physical and mental, which these individuals bring upon themse Ives, because of t h e i r i l l n e s s , cannot be measured, but i t seems clear that providing a coordinated and effective program would be f a r less expensive than the present "nothing for something" approach. In Chapter IV i t i s propsed to summarize the findings of the study, discuss i t s implications and offer some recommendations based on the results of the survey. CHAPTER IV PREVENTION, TREATMENT, REHABILITATION: WHAT ARE THE POSSIBILITIES? Restatement of Focus For many centuries the problem of excessive drinking has constituted a b a f f l i n g and f r u s t r a t i n g phenomenon which has resisted solution. S c i e n t i f i c analysis and treatment have been hindered to a large degree by faulty value judge-ments and negative attitudes which, p a r t i c u l a r l y i n the Western world with i t s Christian philosophy, cast the alcoholic as a "sinner" and a "weak-willed" i n d i v i d u a l . With the r e a l i z a t i o n that many individuals are compulsive drinkers, unable to stop despite the suffering caused by the experience, there has been an increasing attempt to treat the alcoholic through medical, psychological and s o c i a l means rather than condemning him as a moral coward. Yet, despite the efforts of theorists, researchers and professional practitioners, advances are slow and e t i o l o g i c a l factors are not c l e a r . 1 There i s a p a r t i c u l a r minority group of alcoholics who, although they are regarded with disgust and are seen as 1 Cohen, S., Meighan, S.S., Hoover, M.P. and B e l l R.G., Canad. Med. Ass. J., Vol. 84, 1961, pp. 341-343. costly parasites, are perhaps even less understood than the larger group of al c o h o l i c s . Hence, the problem of the skid row alcoholic, although obvious and s t r i k i n g , has been larg e l y ignored. This present study i s intended as a contribution to the understanding of t h i s group by studying i t s characteristics and r e l a t i n g them to R.K. Merton's theory of anomie. Also, an attempt has been made to examine the primary s o c i a l resources to which the skid row alcoholic might turn f o r a i d . The emphasis has been on the l o c a l s i t u a t i o n , but i n the writer's opinion, the findings have relevance for other c i t i e s i n which a s i m i l a r s i t u a t i o n exists. Theoretical Considerations In essence, Merton's theory of anomie states there are persons who reject c u l t u r a l l y valued goals and the i n s t i -tutionalized means of att a i n i n g the goals. The basis of the rejection i s the improbability of attaining these goals through the accepted mea ns, but because both have been internalized by the i n d i v i d u a l , c o n f l i c t i s created. Some use alcohol to enable them to overcome (or repress) this anxiety with the result that they eventually retreat from normal s o c i a l functioning, l i v i n g i n a manner which i s foreign and undesirable to members of the larger society. The skid row alcoholic i s such a person, one who rejects c u l t u r a l goals and means, and who i s rejected by the larger society. The findings of this study tend to support this - 7 3 -t h e o r e t i c a l conception. The information i n regard to age indicate that the process i s slow, involving numerous frustrations and f a i l u r e s . This i s not to say that the individual's poor adjustment i s ent i r e l y due to c u l t u r a l factors, and that constitutional and psychological characteristics are to he ignored. It i s d i f f i c u l t to assess which inadequacies (that i s , c u l t u r a l or individual) play the predominate r o l e . Also, i n respect to age, there appears to be a d e f i n i t e d i s t i n c t i o n between the reasons for the behaviour of the males as compared to that of the females. The small sample of females makes i t d i f f i c u l t to account for the difference, but perhaps i t i s because a alcohol plays a lesser r o l e i n the "retreatism" of the women and that other factors (such as prost i t u t i o n , mental deficiency) are of greater importance. The presence of a large number of Native Indian men (twenty-five) and women (eight) i n the sample suggests that members of t h i s minority group are even less able to adapt to the goals and means of the larger s o c i e t y . 1 The educational achievements of the skid row group suggest that the process of withdrawal from i n s t i t u t i o n a l z i e d 1 Hawthorn, H.B., Belshaw, C.S., Jamieson, S.M., "The Indians of B r i t i s h Columbia and Alcohol", Alcoholism Review, Vol. 2 , No. 3 t Dec. 1 9 5 7 , pp. 1 1 - 1 4 . This a r t i c l e suggests that the laws and mores imposed upon the Indian by the larger society contributed a great deal to pathological drinking. Thus i t i s not simply a question of his a b i l i t y to adapt or adjust, but also i s a matter of cpportunities with which he i s provided. - 74 -means begins early i n l i f e . It i s generally accepted that many young people leave school i n order to earn money (often equat-ed with success), and indicates a rej e c t i o n of the means which the in d i v i d u a l finds too demanding and f r u s t r a t i n g . Certainly leaving school could be accounted f o r by other factors such as i l l n e s s and poverty, and the above contention would require more detailed study. The occupational status of the skid row alcoholic suggests that t h i s i s another indicator of retreatism. Not having a l e v e l of education s u f f i c i e n t to permit a r i s e i n his work position, the alcoholic was limited i n his a b i l i t y to achieve the success goal. Also, by t h i s time the i n d i -v idual would most l i k e l y have discovered the effect of alcohol i n blunting the conscious awareness of fr u s t r a t i o n , causing him to appraise his a b i l i t i e s u n r e a l i s t i c a l l y . His i n a b i l i t y to l i v e up to t h i s image of himself when sober, promotes further use of a l c o h o l . 1 Continued drinking leads to loss of employment which i n turn creates a greater need to maintain a state of inebriety. The findings i n regard to marital status, dependents and next of kin, substantiate the 'belief that skid row alcoholics are unable to sustain close personal relationships. 1 Portnoy, I., "Psychology of Alcoholism", ACAAP, 1947, p. 4. This author's conception of the neurotic base f o r acoholism contributes to our understanding of etiology. - 75 -The f a i l u r e i n marriage i s related to the alcoholics extreme dependency which cannot he tolerated hy his spouse. 1 Many alcoholics r a t i o n a l i z e t h e i r marital f a i l u r e s by saying that i t i s the f a u l t of t h e i r spouses, but i t i s pointed out that neurotic problems among wives of alcoholics develop i n response to stress caused by the husband's drinking, rather p than because of any pre-existing personality disorders. The fact that the majority of the men i n the sample l i v e on skid row i s established by the figures on residence and area of arrest. Once on skid row the alcoholic no longer has to concern himself about condemnation and rejection since he i s among others whose l e v e l of s o c i a l functioning i s as inadequate as his own. He i s able to build his u n r e a l i s t i c self-image without fear of questions or demands for performance. He i s t r u l y isolated from the larger society with i t s pain and f r u s t r a t i o n . The transient nature of the skid row popula-ti o n , even within i t s boundaries, i s suggested by the fact that majority gave "no fixed address" i n response to questions regarding residence. He i s constantly seeking a d i f f e r e n t place to stay, be i t f o r one day, one night, or one week. The 1 lemert, Edwin M., "Dependency i n Married Alcoholics", Quarterly Journal of Studies on Alcohol, Vol. 23, No. 4, 1962, pp. 590-609. 2 Bailey, M.B., Haberman, P. and Alksive, H., "Outcomes of Alcoholic Marriages", Quarterly Journal of Studies on Alcohol, Vol. 23, No. 4, 1962, pp. 610-623. 3 Jackson, Connor, "The Skid Row Alcoholic", p. 316. - 76 -concentration of deteriorated alcoholics i n one small area demonstrates the completeness of the withdrawal phenomenon. Here, the alcoholic insulated hy his drunken state, i s able to l i v e as he wishes with reduced fear of being pressured by r e a l i t y . Religious a f f i l i a t i o n j s t a t i s t i c s appear to add l i t t l e to our understanding of the skid row alcoholic, f o r although nearly half i n the sample were Catholics, other studies have produced d i f f e r e n t r e s u l t s . For example, a study by Feeney of alcoholics sentenced to the workhouse i n Washington, D.C.,-revealed that eighty per cent of the group were Protestant. 1 It has been suggested that because r e l i g i o u s a f f i l i a t i o n i s independent of the individual's functioning, i t i s not an 2 important factor. A more sat i s f a c t o r y indicator would be the alcoholic's church attendance or lack of i t . F i n a l l y , the findings i n respect to arrest records demonstrate the skid row alcoholic's indifference to one of society's strongest deterrents to those who ignore s o c i a l "norms." It has been suggested that repeated arrests and j a i l terms serve only to increase and f i x a t e the alcoholic's pathological dependency. Moreover, t h i s method of dealing 1 Feeney, F.E., Mindlin, D.F., Miniar, V.H. Short, E.B., "The Challenge of the Skid Row Alcoholic", Quarterly Journal  of Studies on Alcohol. Vol. 16, No. 4, Dec. 1955, pp. 48-49. 2 Falkey, D.B., Schneyer, S., "Characteristics of Male Alcoholics", Quarterly Journal of Studies on Alcohol, Vol. 18, No. 1, March, 1957, p. 95. 3 Pittman, D.J., Gordon, W.C., "Criminal Carrers of the Chronic Police Case Inebriate", Quarterly Journal of Studies  on Alcohol. Vol. 19, No. 2, June, 1958, p. 267. - 77 -with the problem serves no useful purpose, while at the same time i t i s costly. In summary, i t can be said that the study establishes the fact of "retreatism" i n the case of the skid row al c o h o l i c . A more detailed examination of individual case h i s t o r i e s would be required i n order to shed l i g h t on the actual mechanics involved. Due to the d i f f i c u l t i e s involved i n obtaining detailed' case h i s t o r i e s , such a study was not attempted. The study of characteristics does not provide much insight into the causal factors which result i n anomie. How much weight can be given to c u l t u r a l determinants as opposed to individual personality determinants such as motivation, ego strengths and dependency? What factors determine that only some individuals end up on skid row while the majority of alcoholics do not? Is i t possible that the majority of alcoholics have such strong allegiance to c u l t u r a l goals and means that they are deterred from extreme deterioration? These and many other questions need to be considered i n order to properly evaluate th i s p a r t i c u l a r theoretical conception. Evaluation of Treatment Services and Other Resources Treatment services to the skid row alcoholic leaves one with the impression that he i s considered a " l o s t cause" upon whom i t i s not worth spending time, e f f o r t or money. Purely medical treatment i s available and given (usually at general hospitals or the Prov i n c i a l Mental Hospital), but stay i n - 78 -hospital i s short and provides only a "drying out" period. Social work involvement i s primarily limited to assessment of immediate needs (food, clothing, shelter) with v i r t u a l l y no continued casework services provided. Diagnostically, the skid row alcoholic i s usually seen as a Sociopathic Personality T r a i t Disturbance, associated with Alcoholism Addiction, which, i n the minds of professional s t a f f , puts him on the lowest step of the p r i o r i t y scale. Following treatment of acute symptoms he i s released to return to skid row to con-tinue as he did previously. The Alcoholics Anonymous groups within the c i t y probably att r a c t a small number of skid row alcoholics, but by and large the majority of members are "hidden" or "respect-able" a l c o h o l i c s . The reasons f o r thi s are not clear, but i t appears that the poor motivation and extreme i s o l a t i o n of the skid row alcoholic prevent voluntary p a r t i c i p a t i o n , even i n such an accepting group. Further, more detailed study i s required i n order to evaluate the factors involved. The B r i t i s h Columbia Alcohol Foundation provides help to a large number of alcoholics, but few of these are from skid row. E.D. MacRae attributes t h i s to the skid row alcoholic's i n a b i l i t y or unwillingness to maintain contact with the Foundation. Also, he does not do as well as the "respectable" alcoholic because of the number and severity of his problems which "require f a c i l i t i e s not provided by the Foundation's treatment and r e h a b i l i t a t i v e s e r v i c e s . " 1 Also, 1 McRae, E.D., Personal Communication, A p r i l , 1961. - 79 -i n a b i l i t y to provide extended r e s i d e n t i a l care and shortage of funds make i t : ...entirely u n r e a l i s t i c f o r government at i t s various lev e l s to expect agencies supported by private funds to provide very costly treatment and services needed for this troublesome, minority group of a l c o h o l i c s . 1 Hence, this agency cannot be considered a resource for t h i s group. The police court would appear a reasonable place to i n i t i a t e treatment of the skid row alcoholic since most of them appear there at least two or three times a year. Yet there i s a regular routine of pick-up, sentence, f i n e or prison and return to skid row. The policemen and o f f i c i a l s who are i n frequent contact with the "drunk" tend to r e f l e c t s o c i a l attitudes and the one most commonly shown i s hopelessness and rejection. This can hardly be avoided as they witness the waste of money and human resources. The missions and shelters, as previously noted, make an attempt to provide alcoholics on skid row with food, shelter and clothing. As well, they appeal to the s p i r i t u a l values of the alcoholic to encourage him to overcome his problem, but i t seems reasonable to assume that the majority of these men have abandoned their r e l i g i o u s b e l i e f s or at least repressed them to a large extent. Further, these 1 McRae, E.D., Personal Communication, A p r i l , 1 9 6 1 . - 80 -agencies are hampered by a lack of funds and f a c i l i t i e s as well as by the public's acceptance of t h e i r limited r o l e . Except f o r a few cases, t h i s service cannot be regarded as anything more than a "stop-gap" measure. In regard to employment, i t i s clear that most skid row alcoholics have l i t t l e contact with employers or the National Employment Service. The fact that he i s usually unskilled means he i s competing i n an area where there i s an over-supply. When this i s added to the severity of his drink-ing problem, i t means that whatever attempts are made are usually unsuccessful. It i s clear then, that much needs to be done p r i o r to seeking employment, p a r t i c u l a r l y i n respect to the individual's physical and mental health. F i n a n c i a l aid i s available to the skid row alcoholic i n the form of a $66 per month s o c i a l allowance grant. He may also be e l i g i b l e for a medical card a f t e r three months on continuing assistance. On the other hand, he may be denied f i n a n c i a l help i f he applies while under the influence of alcohol, i f he i s possibly e l i g i b l e f o r unemployment insurance, or i f he has a poor work history. I f i n receipt of s o c i a l assistance, he may be d i s q u a l i f i e d i f he c a l l s for his cheque while intoxicated, and he cannot receive further i f he has spent his grant on a two or three day "spree." Although many because of the individual i n a b i l i t y to meet these conditions, are off and on s o c i a l assistance frequently, i t does not serve as a deterrent to drinking. Casework services are usually not - 81 -provided i n view of s t a f f shortages and the c h a r a c t e r i s t i c a l l y poor prognosis. While such measures appear legitimate, one must again reach the conclusion that t h i s type of "stop-gap" service i s costly and inadequate. In summary, there does not exist an organized and co-ordinated program fo r the treatment and r e h a b i l i t a t i o n of the skid row a l c o h o l i c . Services provided are costly and limited, and r e f l e c t society's short-sighted approach to the problem. Implications of Findings The results of t h i s study imply a need f o r further assessment as to the application of Merton's theory of retreatism. I f i t i s v a l i d , as the results seem to indicate, then a detailed analysis of individual cases i s i n order so that we might understand his pre-alcoholic personality, reac-t i o n to f r u s t r a t i o n and f a i l u r e , his view of c u l t u r a l goals and means. Histories which would allow an analysis of the process of withdrawal and the causal factors could only be obtained, i n the writer's opinion, through dir e c t interview. Further, a study of the "retreatism" behaviour of such groups as drug addicts might also shed l i g h t upon the v a l i d i t y of Merton's theory and i t s o v e r - a l l application to various forms of s o c i a l disorganization. In the writer's opinion, Merton has devised a framework i n which the skid row alcoholic's behaviour can be evaluated, but i t i s not s u f f i c i e n t l y en-compassing that other medical, psychological and s o c i a l - 82 -theories can he ignored. From a s o c i a l work point of view, i t i s implied that attitudes of pessimism and f u t i l i t y hamper a constructive approach to the problem. While i t i s agreed that prolonged, intensive casework does not seem merited for the skid row alcoholic, i t does not excuse the professional person from taking responsible action. Social workers are frequently confronted with the costly, wasteful aspects of th i s i l l n e s s . Hence, they can be instrumental i n meeting the needs of th i s group, not so much on an individual basis, but through advocating the setting up of an adequate, comprehensive program. It i s a matter of s o c i a l action rather than therapy i n the beginning. Even where the s o c i a l worker provides only b r i e f services to the alc o h o l i c , his attitude and approach can be important i n determining future behavior. I f he i s abrupt, uses derogatory remarks and b e l i t t l e s the alcoholic c l i e n t , i t confirms for the person that he. i s hot: to-be helped i n coping with his problem. The s o c i a l worker's "d i s c i p l i n e d use of s e l f " i s often more essential here than with c l i e n t s who have different problems. Care must be taken so that the quality of casework i s not affected by detrimental value judgements. While i t i s recognized that the time available to each c l i e n t i s usually minimal, s t a f f shortages and i n -s u f f i c i e n t f a c i l i t i e s are not problems for which the alcoholic can be held responsible and does not j u s t i f y unprofessional behaviour. - 83 -The implications for the community are, i n the writer's opinion, very clear. It i s a matter of either ignoring a costly and increasing problem or dealing with i t (which i s also costly) i n terms of increased and more effective services. The existence of such groups i n the society serve as reminders that there are severe weaknesses i n a s o c i a l structure which allows such deterioration and waste. The emphasis upon material gain i s certain to result i n many casualties, implying a need to reassess our value structure. It i s important that individuals and groups i n the society recognize alcoholism as partly a s o c i a l i l l n e s s , rather than a t t r i b u t i n g the "casualties" s o l e l y to individual weakness characterized by lack of " w i l l power". It would appear that the public i s beginning to r e a l i z e and accept that the alcoholic i s a sick person, although the concept i s vague, without r e a l depth."*" There i s a r e s p o n s i b i l i t y for professional persons to define the i l l n e s s more c l e a r l y i f public support i s to be gained i n the development of adequate programs* Proposals for Further Study As has been indicated by Marriage, there i s no con-sistent theory of alcoholism and hence further coordination 1 J e l l i n e k , The Disease Concept of Alcoholism, pp. 182-185. - 84 -o f e f f o r t i s r e q u i r e d i n t h i s a r e a . 1 I n r e s p e c t t o t h e l o c a l s i t u a t i o n , i t i s s u g g e s t e d t h a t a n e x h a u s t i v e s t u d y o f s k i d r o w a l c o h o l i c s b e c a r r i e d o u t i n t h e b e l i e f t h a t t h i s w o u l d b e l e s s e x p e n s i v e t h a n i g n o r i n g t h e p r o b l e m a n d h o p e f u l l y w o u l d l e a d t o t h e d e v e l o p m e n t o f a s e n s i b l e t r e a t m e n t p r o g r a m p f o r t h e s e i n d i v i d u a l s . P e r h a p s a s E . D . McRae s t a t e s , m o s t c a n n o t b e " s a v e d " b u t some a c t i o n m u s t b e t a k e n t o s t o p t h e i n c r e a s e i n w a s t a g e w h i c h a t p r e s e n t c o n t i n u e s t o i n c r e a s e . T o do t h i s p r o p e r l y , a s t u d y o f t h e p r o b l e m mus t be c a r r i e d o u t f i r s t . The P r o b l e m o f P r e v e n t i o n The c o n c e p t o f p r e v e n t i o n i m p l i e s a k n o w l e d g e o f t h e c a u s e o r c a u s e s o f a p a r t i c u l a r d i s e a s e a n d w i t h a l c o h o l i s m t h e r e i s l i t t l e a g r e e m e n t a s t o t h e e t i o l o g i c a l f a c t o r s i n -v o l v e d . H e n c e , i t i s d i f f i c u l t t o make f i r m r e c o m e n d a t i o n s a s t o w h a t p r e v e n t a t i v e s t e p s may b e t a k e n . B u t , i t w o u l d seem p o s s i b l e t o a v o i d t h e s e v e r e d e t e r i o r a t i o n w h i c h i s s e e n i n t h e s k i d r o w a l c o h o l i c . I n t h e f i r s t i n s t a n c e t h e p r o c e s s i s r e l a t i v e l y s l o w and s e c o n d l y , t h e r e w o u l d a p p e a r t o b e s e v e r a l c r i s i s p o i n t s i n t h e l i f e o f t h e a l c o h o l i c w h e r e h e t u r n s t o a l c o h o l . C o n s e q u e n t l y , a w a r e n e s s o f t h e p r o b l e m 1 M a r r i a g e , The P o l i c e C o u r t D r u n k e n n e s s O f f e n d e r , p . 12. 2 M c R a e , E . D . , T h e V a n c o u v e r S u n , D e c . 12, 1961, p . 1. - 85 -must be extended to the l e v e l of the family, the school and the employer. Education of the i n d i v i d u a l i s needed so that the majority of people are reasonably conversant with the symptoms of excessive, continued dependence ton alcohol. As i s pointed out by one group of writers, public education i s the largest single factor i n dealing with alcoholism and the individual must be made to r e a l i z e that he cannot recover alone."*' Continued research w i l l hopefully i s o l a t e the import-ant causes of the disease, but u n t i l such time as this i s achieved the individual must understand that i n the use of alcohol there i s an element of danger. It i s not simply a matter of " w i l l power." It i s suggested that as well as prevention on i n d i -vidual l e v e l , c u l t u r a l stresses leading to alcoholism must be taken into consideration. The Native Indian al c o h o l i c presents a s t r i k i n g example of the effect of discrimination and unequal opportunity. How these are related to individual and sub-culture weaknesses must be evaluated. For the larger society, the reappraisal and change of detrimental value judgements and goals i s suggested as an aid to prevention of deviations such as alcoholism. The d i v e r s i t y of factors which appear to be involved i n the genesis of the i l l n e s s i s i n d i c -ative of the need for more d e f i n i t i v e study before preventative measures can be devised with certainty. 1 Cohen, et a l , Canad. Med. Ass. J., pp. 341-343. - 86 -Treatment and Rehabilitation While each alcoholic requires individualized t r e a t -ment, th i s does not negate the need for comprehensive programs aimed at dealing with the problem as a whole. 1 Potts has indicated that f o r non-skid row alcoholics, an intensive thirty-day treatment program followed by after-care, i s help-f u l , but i t i s not enough to meet the needs of those who are 2 severely deteriorated. The types of services which would be included i n a comprehensive program are suggested by Block, although p r i o r to the setting up of these, a thorough study of the l o c a l s i t u a t i o n i s needed to avoid waste and duplica-t i o n . The services which he suggests are: in-hospital; out-patient c l i n i c s ; foster homes; half-way houses; r e h a b i l i t a -t i o n centres; permanent supervision units; state hospitals. Commenting on the need for this type of set-up, Hindman says, It seems to me that one of the things that i s pretty evident i n this f i e l d i s that when you provide more elaborate programs on a higher l e v e l of i n t e g r i t y and e f f i c i e n c y for the skid row area, the response i s heartening.4 1 Marriage, The Police Court Drunkenness Offender, p. 20. 2 Potts, P.J., " I n s t i t u t i o n a l Treatment f o r the Alcoholic i n Ontario", Institute on the Skid Row Alcoholic, March, 1956. 3 Block, M.A., "A Program fo r Homeless Alcoholics", Quarterly Journal of Studies on Alcohol, Vol. 23, No. 4, Dec. 1962, pp. 644-649. 4 Hindman, W.L., Institute on the Skid Row Alcoholic, March, 1956, p. 6. - 87 -It i s proposed then that the problem be studied with a view to setting up such a program. In proposing s p e c i f i c services there i s f i r s t of a l l a need for emergency shelters and c l i n i c s to deal with the acute needs of the a l c o h o l i c . Such agencies would be located within the skid row area and also would serve to r e f e r tmore d i f f i c u l t cases to appropriate resources. A further recommendation i s that s o c i a l workers be assigned to the court i n order to assess cases to determine individual needs. A study by Thomas and Walker revealed that by screening alcoholics who appear i n court, i t was possible to prevent further deterioration and obtain a good l e v e l of s o c i a l func-tioning i n many cases. 1 It i s proposed also that the court have the power to act upon professional recommendations and commit severely deteriorated alcoholics to i n d e f i n i t e care i n an i n s t i t u t i o n a l setting. Where possible t h i s should be done with the cooperation of the i n d i v i d u a l concerned and i f done against his wishes, mandatory provision for appeal within, a reasonable period (sixty days) should be made. I f a f t e r t h i s period the alcoholic refuses further treatment, he could not be detained unless he were considered dangerous to others, since protection of c i v i l rights must be insured. This i s 1 Thomas, R.E. and Walker, D.R., "Casework Services for Alcoholics i n a Magistrates Court", Social Work, Vol. 5, No.l, Jan. I960, pp. 33-8. - 88 -preferable to a thirty-day j a i l sentence, af t e r which the individual would return to skid row. 1 A t h i r d proposal i s that an adequate f i n a n c i a l aid program be established. It i s foolhardy to expect a deteriorated alcoholic to r e h a b i l i t a t e himself on $66 per month when t h i s would tax the ingenuity of a normal person. Exjent of aid must be based upon ind i v i d u a l need, recognizing that safeguards (such as continued follow-up) would have to be devised. Further to t h i s an adequate f i n a n c i a l aid program implies something more than simply providing for the basic needs (food, clothing, shelter) of the i n d i v i d u a l . It requires that there be more, q u a l i f i e d s t a f f to help the alcoholic make the best use of his funds both for his own betterment and that of the community. Social workers who are harassed by large caseloads can become impatient with c l i e n t s who require-, a good deal of time and support before progress i s made. Improvement i n services designed to locate jobs i s necessary for those who are able to work. Educational and vacational programs which raise the employability of the men are necessary as well. Hence, i t i s essential that the scope of our public assistance program be broadened, for as i t operates presently i t i s something less than a half-way measure. 1 For an assessment of the short-comings of programs which do not provide adequate long-term treatment see Harris, S. Skid Row U.S.A., pp. 201-285. Also, see Hindman, Institute on  the Skid Row Alcoholic, p. 5. - 89 -The cornerstone of a program for skid row alcoholics would be the provision of long-term r e s i d e n t i a l care. While the majority of alcoholics would require only short-term treatment, Krimmel and Palkey., who are strong advocates of this type of program, state that, Short-term treatment i s not advocated for a l l a l c o h o l i c s . It i s most effective with those who have reasonably intact emotional and environmental resources that can be mobilized when the barrier of excessive drinking has been removed. Chronic alcoholics needing h o s p i t a l i z a t i o n or those with gross personality disorders can seldom be treated successfully without long, intens-ive therapy. The single unattached alcoholic i s also a poor short-term r i s k , without the support of family or friends constantly around him, he may f i n d i t much more d i f f i c u l t to replace alcohol with other s a t i s f a c t i o n s . The agency usually must supply this support for a long time. Indeed, with t h i s group the best effo r t s of a c l i n i c or agency may not be enough, because the interminable day between weekly appointments offe r nothing but the bleak loneliness of a room without companionship.1 It must be recognized that there are many problems associated with escaping skid row and i n s t i t u t i o n a l care would help the alcoholic to accomplish t h i s as well as s i g n i f y i n g society's 2 acceptance that alcoholism i s an i l l n e s s . Brown believes that many skid row alcoholics require a supervised setting with complete abstention from alcohol. He states further that: 1 Krimmel, N.E. and Falkey, D.B., "Short-term Treatment of Alcoholics", Social Work. Yol. 4, No. 4, p. 107. 2 Jackson, and Connor, "The Skid Row Alcoholic", pp. 320-323. - 90 -The individual should he committed f o r an ind e f i n i t e period f o r treatment leading to possible recovery. The reason for commitment should be a history demonstrat-ing that he i s s o c i a l l y inadequate - not crimes or offences he may have committed.1 Conversely, i t i s d i f f i c u l t to establish c r i t e r i a which measure the s o c i a l adequacy, except where gross abnormality i s present. The fact that the alcoholic's behavior may be considered harmful to himself, i s i n s u f f i c i e n t j u s t i f i c a t i o n for removal of his c i v i l r i g h t s . To have the authority to dictate how another s h a l l l i v e i s a serious matter and emphasis must be placed upon voluntary i n s t i t u t i o n a l t reat-ment. Where the decision i s made by someone other than the alcoholic there i s the r i s k that such powers may be abused and safeguards (such as, appeal by the individual, a r e l a t i v e , or an interested person; boards of review; proba-tionary periods) must be provided. These are necessary p a r t i c u l a r l y where there i s a p o s s i b i l i t y that the ind i v i d u a l could become " l o s t " on a purely custodial care ward of an i n s t i t u t i o n . Should i n s t i t u t i o n a l treatment be deemed necessary, i t must be remembered that many skid row alcoholics may never be capable of functioning on a completely independent l e v e l . Myerson 1s study of a group of skid row alcoholics emphasizes the need to recognize the limi t a t i o n s of t h i s type of treatment. 1 Brown, P.R., "The Problem Drinker and J a i l " , O.J.S.A.. Vol. 16, No. 3, Sept., 1955, p. 483. - 91 -Of 101 men who were studied f o r a period of three years, only 54 showed any improvement i n the drinking problem. Of these, only 12 were able to remain completely independent of the hospital for any length of time. 1 He expresses the view of the majority of writers i n this f i e l d i n stating that, Taking into consideration the chronic v u l n e r a b i l i t y of t h i s group of men, those responsible for the program should r e a l i z e that anything but a long-term approach with adequate f a c i l i t i e s for follow-up i s a f u t i l e gesture.2 In practice, l i f e - l o n g i n s t i t u t i o n a l i z a t i o n would be necessary only i n a very few cases. For the majority, a shorter period of r e s i d e n t i a l care, complemented by medical, psychiatric and s o c i a l r e h a b i l i t a t i o n programs could lead to a restoration of an adequate l e v e l of s o c i a l functioning, without alcohol. The writer r e a l i z e s that adequate programs for the skid row alcoholic pre-suppose an enlightened public and u n t i l the moral c o n f l i c t surrounding alcoholism i s resolved, changes w i l l be slow to take place. Over the years there have not been s i g n i f i c a n t changes i n the general attitude toward alcoholism. The following statement, made twenty years ago, regarding what i s needed to solve the problem, i s just as v a l i d today. To solve the increasing problem of inebriety successfully, we need more than improved 1 Myerson, D.J., "Three Year Study of a Group of Skid Row Alcoholics", AAAS, 1957, pp. 151-161. 2 Ibid., p. 160. methods of helping the individual alcoholic. We need changes in our thinking and social structure which c a l l for concerted actions of a l l c it izens. We need a philosophy of l i f e with a different sense of values, with saner measures of man's worth and success than the materialistic and self-centred ones now a l l too prevalent . . . .1 This thesis represents an attempt to add to our general knowledge of the problem of alcoholism by studying the characteristics of a minority group of severely dete-riorated alcoholics. Specif ical ly, i t is a survey of the local situation and points to the need for more intensive study. It indicates the widespread effects of this group, points to the ineffective way the problem is handled, and shows the need for increasing public consciousness about the i l lness . When one considers that this study could be repeat-ed in hundreds of North American centres, then much is to be gained by developing sensible programs designed to cope with the problem of the skid row alcoholic. 1 Boggs, M.H. , "The Role of Social Work in the Treatment of Inebriates", Quarterly Journal of Studies on Alcohol, V o l . 4, No. 4, March, 1944, p. 567. BIBLIOGRAPHY Books Canada Year Book. Dominion Bureau of S t a t i s t i c s , Queen's Printer, 1962, p. 1231. Gibbins, R.J. Chronic Alcoholism and Alcohol Addiction - A Survey of Current Literature, Alcoholism Research Founda-tion, Ontario, 1953. Harris, Sara. Skid Row. U.S.A. Doubleday, New York, 1956. Je l l i n e k , F.M. The Disease Concent of Alcoholism. Hillhouse Press, I960. Kant, F. The Treatment of the Alcoholic. 1954.. Kelly, N.L. Alcoholism and Social Experience, ARP Project No. 3, North Carolina Alcoholic Rehab. Program, 1954. Marriage, A. A Study of the Police Court Drunkenness Offender  and Survey of Contemporary Methods of Care, Pub. By the Alcohol Foundation of B r i t i s h Columbia, 1957. Merton, R.K. Social Theory and Social Structure, Free Press, I l l i n o i s , 1957. Hayes, A.P. and Kolb, L.C. Modern C l i n i c a l Psychiatry, W.B. Saunders Co., 1958. Paphom, R.E. and Schmidt, W. S t a t i s t i c s of Alcohol Use and  Alcoholism i n Canada. 1871-1956, Alcoholism Research Foundation of Ontario, U. of Tar. Press, 1958. Stagner, R. Psychology of Personality, McGraw-Hill, 2nd Ed., 1948. Journals and A r t i c l e s Alcohol Foundation of B r i t i s h Columbia, 6th Annual Report. 1959. - 94 -Alcoholism Review, Vol. 1, No. 1, A p r i l , 1955. Vol. 1, No. 2, August, 1955. Vol. 1, No. 3, December, 1955. Vol. 1, No. 4, A p r i l , 1956. Vol. 1, No. 5, August, 1956. Vol. 2, No. 2, August, 1957. Vol. 2, No. 3, December, 1957. Ardies, T. Vancouver Sun. Feb. 6, 1963, p.6. Avol, M. and Vogel, P.J. "A New Treatment for Delirium Tremens", Alcoholism: Basic Aspects and Treatment, Pub. No. 47 of the Amer. Assoc. for the Advancement of Science, 1957, pp. 115-123. Boggs, M.H. "The Role of S o c i a l Work i n the Treatment of Inebriates", Q.J.S.A., Vol. 4, No. 4, March, 1944, PP. 557-567.1 Bailey, M.B., Haberman, P. and Alksne, H. "Outcomes of Alcoholic Marriages: Endurance, Termination or Recovery", Q.J.S.A., Vol. 23, No. 4, D e c , 1962, pp. 610-623. Bailey, M.B. and Fuchs, E. "Alcoholism and the Social Worker", Social Work. Vol. 5, No. 4, Oct., I960, pp. 14-19. Becker, G.S. and I s r a e l , P. "Integrated Drug and Psycho-therapy i n the Treatment of Alcoholism", Q.J.S.A., Vol. 22, No.4, Dec. 1961, pp. 610-633. Belden, M.A. "A Program f o r the Treatment of Alcoholics i n a Mental Hospital", Q.J.S.A.. Vol. 23, No. 4, Dec, 1962, pp. 650-653. Block, M.A. "A Program fo r Homeless Alcoholics", Q.J.S.A., Vol. 23, No. 4, Dec. 1962, pp. 644-649. Brown, P.R. "The Problem Drinker and J a i l " , Q.J.S.A., Vol. 16, No. 3, Sept. 1955, pp. 474-483. Chafetz, M.E. " P r a c t i c a l and Theoretical Considerations i n the Psychotherapy of Alcoholism", Q.J.S.A., Vol. 20, No. 2, June, 1959, pp. 281-291. 1 "Q.J.S.A." refers to the Quarterly Journal of Studies on Alcohol and i s abbreviated for convenience. - 95 -Chane, M. "The Homeless Woman Alcoholic", Annual Conference of the National Committe on Alcoholism, Hotel Statler, New York City, Institute on the Skid Row Alcoholic, The Committee on the Homeless Alcoholism, Thursday, March 29, 1956. Cohen, S., Meighan, S., Hoover, M.P. and B e l l , R.G. Can. Med. Assoc. Journal. Vol. 84, 1961, pp. 341-343. Davis, P.M. and Ditmon, K.S. "The Affect of Court Referral and Disulfram on Motivation of Alcoholics", Q.J.S.A., Vol. 24, No. 2, June, 1963, pp. 276-279. E d i t o r i a l , Vancouver Sun, p. 4, Dec. 5, I960. Palkey, D.B. and Schenyer, S. "Characteristics of Male Alcoholics Admitted to the Medical Ward of a General Hospital", Q.J.S.A.. Vol. 18, wo. 1, March, 1957, pp. 67-97. Feeney, F.E., Mindlin, D.F., Miniar, V.H. and Short, E.E. "The Challenge of the Skid Row Alcoholic - A Social, Psychological and Psychiatric Comparison of Chronically Ja i l e d Alcoholics and Cooperative Alcoholic C l i n i c Patients", Q.J.S.A.. Vol. 16, No. 4, Dec. 1955, pp. 645-667. Gordon, C.W. "Social Characteristics and L i f e Career Patterns of the Skid Row Alcoholic", Annual Conf. of the National Cte. on Alcoholism, New York, March 29, 1956. H i l l , H.E. "The Social Deviant and I n i t i a l Addiction to Narcotics", Q.J.S.A., Vol. 23, No. 4, Dec. 1962, pp. 562-582. Hindman, W.L. "The U t i l i z a t i o n of Modern Technique i n Treat-ment of the Skid Row Alcoholic i n the Southwest", Annual Conf. of the National Cte, on Alcoholism, N.Y., March 29, 1956. Jackson, J.K. and Connor, R. "The Skid Row Alcoholic", Q.J.S.A.. 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Swensen, CH. and Davis, H.C "Types of Workhouse Inmate Alcoholics", Q.J.S.A., Vol. 29, No. 4, Dec. 1959, pp. 757-766. Thimann, T. "Newer Drugs i n Treatment of Acute Alcoholism with Special Consideration of Meprobamate", Alcoholism: Basic Aspects and Treatment. Ed. Himwich, H.E. Pub. No. 47 of the AAAS, 1957, pp. 123-128. Thomas, R.E., James, H., Walker, D.R. "Casework Services f o r Alcoholics i n a Magistrates Court", Social Work, Vol. 5, No. 1, Jan. I960, pp. 33-38. Wenneis, A.C "Responding to the Emotional Needs of the Alcoholic", Social Casework. Vol. 38, No. 4, A p r i l 1957, pp. 189-193. Personal Communication Edward, A. Vancouver Police Court, Personal Interview, Feb., 1961. Holland, Norman. Police Court Clerk, Vancouver C i t y Police Department, Personal Communication, March, 1961. McRae, E.D. "The Skid Row Alcoholoc", Personal Communication, A p r i l 12, 1961, p. 4. 

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