Journal o[ Studies on Alcohol, Vol. 38, No. 11, 1977
Counseling Homosexual Alcoholics Ten
Case Histories
Edward J. Small,Jr? and Barry Leach, Ph.D? SVMM.•aY.The case historieso• 10 male homosexualalcoholicsare presented, and ps•tchoanal•tictheoriesabout the link between homosexualit•and alcoholism are reviewed.
WO MODERN STUDIES of homosexual men,discussed below,suggest a highincidence of alcoholism in thatpopulation. Our own clinicalexperience,moreover,is that almost one-thirdof the men seekingcounseling or treatmentfor alcoholism are concernedabout homosexuality. For at leasttwo reasons, it seemslikely that an increasingnumber of problem drinkersseekinghelp in the future will identify themselvesas homosexuals: growth of the "Gay Liberation"movement (1), and the AmericanPsychiatricAssociation's removal of homosexuality from its official list of mental illnesses. The case sketchesthat follow suggestthat homosexualityand alcoholism in menareprobablyindependentstates,and that homosexualityneed not be an obstacleto therapyor recoveryfrom alcoholism under certain conditions.
Homosexualityhas been linked to alcoholismor inebriety in theoreticalformulationsin the psychiatricand psychological literaturefor decades(2-6). Someof Freud'sreinterpreters,linking oral tendenciesto homosexuality, proposedthat the etiology of alcoholism is homosexuality. Ferenczi(7, 8) and Knight (9) saw in compulsivedrinkingan attempt to allay anxiety over masculine inadequacy,resultingfrom an overindulgentmother, traumatic weaning,the father'semotionalcoldness,and envy of the father's penis.Bergler (10) offereda similarformulation,noting that an • 99 East Fourth St., New York, NY 10003. .o100 Bank St., New York, NY 10014. Receivedfor publication: 22 February 1974. Revision: 2 March 1977. 2077
2078
v,. j-. S•'[ALL,JR. ANDB. LEACH
alcoholic'shomosexuality is latent. Abraham s held that oral frustration resultedin overidentificationwith the father, amounting to latent homosexuality,and that alcoholicscould expresstheir "deviant"urgesunder the influenceof alcoholwithin the "male" camaraderie of the saloon.Rad6 (12) declaredhomosexuality an irrationalfear of being heterosexual, presumablydissolvedby alcohol.In her extensivereviewof psychoanalytic viewsof alcoholism Blum (13) describedlove relationships established by an alcoholic as "supportingevidencefor an oral fixation or regression," but alsonoted that fixationat the anal stageoften resultsin "lovefor others, albeit of the same sex."
From many such formulations,it might be inferred that overt homosexuality avertsalcoholism,or that no one can manifestboth alcoholism andoverthomosexuality. The emphasis on oralityseems to define homosexuality almostexclusivelyas a drive to perform fellatio;noneof the theoriesaccountfor the frequencyof manual masturbation, anal intercourse, flagellationor any otherhomosexual (and heterosexual)practices,not to mentionobservableenduring marriage-typeor love relationsbetweenhomosexuals. Psychoanalytic assertions do not constitutehard evidence,of course,nor do they accountfor all homosexuals, repressedor overt, who do not become alcoholics,for all women homosexuals,for all women al-
cholics,for all heterosexual alcoholics, or for all "gay"male alcoholics who drink outside saloons.
As Saghirand Robbins(14), Madsen(15), and Weinbergand Williams (1) have noted,yearsof researchhave not led to agreement on either the definitionor the etiologyof homosexuality, or evenwhetherthere is indeedone suchcondition,personalitytype, or patternof behaviorwhich can be clearlydelineated.Neverthe-
less,someinvestigators havetried to determinein smallsamples whetherthereis an association betweenalcoholism and what they considerhomosexuality. Landis (16) comparedthe personalities of 29 drinkingand 25 remitted alcoholics and 21 nonalcoholic controls and found no re-
lationships betweenhomoeroticism and alcoholism; nor couldQuaranta (17) find sucha tie. Machoveret al. (18) reportedfinding what they judged to be homosexual "trends"more in evidence among29 drinkingalcoholics,but did not find the tendenciesmore prevalent among men alcoholicsthan among nonalcoholic,preCited in Fenichel (11).
COUNSELING HOMOSEXUAL ALCOHOLICS
2079
sumednonhomosexual, controls.McCord and McCord (19), in their longitudinalretrospectivestudy of alcoholics,found that "overtly homosexual" pubescentboys (N--6) were slightly more likely to becomealcoholics than"feminine"boys(thosewho playedwith dolls, expressedthe wish to be girls, or wore some feminine clothes),contradictingthe pseudo-Freudian contentionthat latent homosexuals have greater vulnerabilityto alcoholismthan overt ones.The McCords concludedthat their research"doesnot support the belief that alcoholicshave latently homosexualpersonalities"(19, p. 32). Prout et al. (20) found homosexuality in only 4 of 100hospitalizedmen alcoholics.Botwinickand Machover(21), having searchedfor homosexuality, latent or patent, in alcoholics, concludedthat "homosexuality cannot be an essentialfactor in alcoholism"(p. 272). Gibbinsand Walters (22) testedthe psychoanalytic theory that alcoholismis linked to repressedor latent homosexuality, using threeperceptual defenseexperiments on 179mensubiects , of whom 36 were manifesthomosexuals ("arrestedfor homosexual offenses") and 43 were patientsin an alcoholismclinic.The 100 controls,presumablyneither alcoholicnor prealcoholic,neither overtly nor covertly homosexual,were men who regularly attended YMCA (Young Men's ChristianAssociation) functions.Resultsof the first two experimentsdid not afford unequivocalsupportfor the tested theory,the authorsreported,and in the third, "responses of alcoholics were intermediate
between those of homosexuals and normal
subiects"( p. 640). So, althoughsexualidentity (not homosexuality qua homosexuality) canundoubtedly be a problemfor somealcoholics asfor some nonalcoholics,there is no clear evidence that alcoholism is caused
by homosexuality. Factorswhichproduceone may alsosometimes producethe other, but evidencefor this is also lacking. The only link or relationship betweenalcoholism and homosexuality may be their occasional occurrence within the same individual.
Nevertheless, two recent studiessuggestthere may be a relatively high incidenceof drinking-relatedproblemsamong.men homosexuals. AlthoughBarr et al. (23) concludedthat recentevidencefromstudiesof homosexuals who are not psychiatricpatients suggeststhat homosexuals are not more neuroticthan comparable
heterosexuals theyfoundproblemdrinkingamong30%of theirhomosexual population and in only20%of the heterosexual controls. Weinbergand Williams (1) studied2497 male homosexuals (1117
2080
E.J. SS•ALL,Ja. ANDB. LEACH
in the United States,1077in the Netherlands,and 303 in Denmark) and found no differencesin psychological problemsbetween the homosexual and generalpopulationsamples;they concludedthat sexualorientationis not necessarily correlatedwith psychological problems.But they alsonoted that 29.4%of their homosexual sample reported"drinkingmore than they should,"i.e., nearly "all the time"; another31.3%,"pretty often";and 30.4%reportedfrequentinga "gay"bar onceor more a week.Other Weinbergand Williamsfindingscould also correlatewith drinkingproblems,althoughno direct relationshipis shown.For example,subjectsreporting seeinga psychiatrist,sufferingfrom tremors, dizziness, nightmares, sweatyhands,guilt, depression, loneliness, job dissat-
isfactionand job changes couldbe revealingalcoholism. The followingcasehistoriesare believedto typify the coincidentaloccurrence of homosexuality in men in contemporary American culture.They appearto illustratethe hypothesisthat the two conditionsare most likely to coexistcircumstantially rather than causatively, but as they do not constitutea representative sample of either conditiontheir worth is only suggestive.The patients are all White men seenby us during a combinedtotal of 15 years of workingwith alcoholicsas an alcoholismcounselorin an industrial settingandin a programfor drinkingdrivers,andasa psychotherapistin privatepracticein association with a psychiatrist. CASES
Case 1. J.B., an American-bornman, presentedfor treatment at the age of 27. There was no family historyof alcoholism. He began experimentaldrinking and homosexualbehavior in high school,where he was an athletic star, continuingthrough 4 years of collegeand 2 of voicestudyin Italy, with occasional periodsof abstinence and continence.Alcoholismbecame severe during 3 years of professionalsingingin New York. He sought psychiatrictreatment, convinced that a mental disorder caused the homosexual behavior and
that this was at the root of his excessive drinking.During 3 years of grouptherapyhe resistedsuggestions to try AlcoholicsAnonymousand found homosexuality in himself or othersunacceptable.During times of abstinencehe refrained from sexualactivity, convincedhe would "getover"beinghomosexual, marry and havechildren.Failure to fulfill a professionalengagementbecauseof drunkenness persuadedhim to follow group adviceand concentrateon abstinenceby becomingan A.A. member.After a year of abstinencehe began to feel comfortable with other "gay"A.A. members,enteredinto a homosexualmarriagetype relationshipwith anotherA.A. member,and maintainedcontinuous
COUNSELING HOMOSEXUAL ALCOHOLICS
2081
abstinence. The relationship haslasted3J4years,and J.B. hasterminated psychotherapy.
Case 2. J.M., an American-bornJewishadvertisingwriter, at age 58 was referredby a countycourt to a rehabilitationprogramfor "drinking drivers."He reported that both his parentswere alcoholics. After 4 weeks in the court program,J.M. announcedthat he was a homosexual,not an alcoholic.Sexual activity with both men and womenhad begun at age 14 and continuedunabated after his marriage at age 21, which ended in divorce10 years later. At that time he had never drunk excepton ceremonialoccasions,but after the divorce he becamea heavy solitary drinker, isolatinghimself except during work hours and about once a month when he would get drunk and participate in homosexualorgiesat a Turkish bathhouse.He called himself a "fag baiter and beater"and took elaboratepainsto appear aggressively unattractive,masculineand hostile.He said he was stunnedby a counselor'ssuggestion that he might be both homosexualand alcoholic,both happy and sober."Beinghomosexual won't kill me, but drinkingwill," he finally announced.Highly intelligent and well motivated, he acceptedreferral to a psychotherapist in private practice,to A.A., and to
a "gay"socialclub in which he never developedany interest.After 6 monthsin the driver program, he was discharged.Two and a half yearslater he is still abstinent,active in A.A. (in both homosexualand heterosexualgroups), and sayshe leads a promiscuous "gay" sex life outsideA.A. He has terminatedpsychotherapy. In the last year he has had dramaticprofessional success. Case3. R.C., an American-bornRomanCatholicpriest of Italian parents,was referredfor counselingat age 42 by a priest friend after his third suicideattempt.His mother,a physician,becamean alcoholicin middle age. R.C. reportedbeing a heavy user of alcoholand tranquilizerssince
seminarydays.He speaksfive languages, hastwo doctoraldegreesand in his youth was considereda promisingfiction writer. He was infuriated by the suggestion of alcoholism, sayinghe drank only because of fury at the superiors of his orderxvhodeclinedto let him practice an openly"gay"ministry.He had read widely about alcoholism, about A.A. and about homosexuality. He insistedhe enjoyedbeing "gay," but admittedexperiencinglengthy depressions. He saw each sexual contact as the start of a sort of "betrothal" which was sure to lead to
"marriage,"which would in turn make his homosexualbehavior ac-
ceptable.He agreedreluctantlyto attend"gay"A.A. meetingswith another priest, also a homosexual alcoholic.Eight monthslater they formeda domesticpartnership, and R.C. left the priesthood to enter business. He hasnowbeenabstinent 28 months,is successful in a highly structuredcommercial enterprise,is writing fiction again and is active in A.A. He believeshis recoverybeganwhenhe couldacceptidentity first as an alcoholic, then as a homosexual. He believes he will even-
tually becomea communicant in his faith again.
2082
E.j.
SMALL, Ja. AND B. LEACH
Case 4. G.M., a New York-bornPuerto Rican, had begun recovery from alcoholism at age 36 with the aid of A.A. He saidhis father was a "reformed drunkard" who did not drink.
After 10 monthsof abstinenceG.M. soughtcounselingthrough his
employer's healthprogram because he had fallenin lovewith a fellow laborerand was deeplydepressed and 'fearfulthat he was a "queer." He had beena heavyuserof wine and beer in high school,but alcoholismwas not diagnoseduntil his foremanhad urged him to go to A.A. He had had sexualexperiences with many men and women,beginningin schooldays,but had been able to reachorgasmonlywith men. During the last 5 yearsof his alcoholism, however,he became impotentandsaidhe had decidedsexwashighlyoverrated in America. Abstinence had restoredhis potency.He first describedhimselfas "30g gay, 70g straight,"but after 8 monthsof counseling he reversedthe proportions. He is still abstinent, 5• yearsafter counseling terminated, and sayshe is contentwith a "gay"identitybut still unhappyat what he feels is the necessityfor hiding it. He sayshe used homosexuality as the excusefor heavy drinking. Case 5. M.S., an American-bornIrish•nan,at age 43 referred himself
to his company's alcoholism programat the urgingof A.A. friends. Orphanedin infancy,M.S. was reared by foster parentswho were prohibitionists. He wasabstinentuntil age 29, when he got drunkafter the break-upof his third engagement. His drinkinghas been periodic and pathologicalever since.He reportedbeing repeatedlyraped by an olderman in early childhood,and recallsno other sexualexperience exceptsolitarymasturbation until after he beganto drink,when he also begangoingto "gay"barsin a searchfor a homosexual lover,"in bitter resignation,"he said. This was revengefor the broken engagements, he feels.At 35 he enteredpsychiatrictreatment,and at 37 joined A.A. Until 8 monthsago he had never remained abstinentlonger than 2 months,alwaysgoing on a binge at the break-upof a "love affair." Eight monthsago, however,he began taking disulfiramdaily, and he now seemsdelightedthat he can have sexualexperienceswhile sober and without
emotional involvements. His attitude
toward A.A. has be-
come noticeablymore positive. Case 6. F.S., American-bornof German parents,referred himself for grouptherapyat age 37 after a year of sobrietyin A.A. There was no family history of alcoholism. F.S. began intensivehomosexualactivity and heavy drinking in college, but neither preventeda rapid rise to financial successon Wall Street.At 35, depressedabout failure to achieve any enduringhomosexuallove relationship,he entereda "gay" self-helpgroup.The group persuadedhim to go to A.A., but after a year'sabstinence he was still unhappy,complainingof hypoglycemia,which no medicalexamination could confirm, and of migraineheadaches.During 2J•years in group therapyhe has remainedabstinentand has begun to reassess his goals as a homosexual. He has becomea leader in the "Gay Liberation"move-
COUNSELINGHOMOSEXUAL ALCOHOLICS
2083
ment and is less concerned about so-called love affairs. He is active
in A.A. and his somaticcomplaintshave virtually disappeared. Case 7. J.P. referredhimselfat age 45 for outpatienttreatmentfor alcoholism.There was no family history of alcoholism. Born in Kansas,the patient began drinking while working for his doctoratein economics, shortlybeforemarryinga medicalstudent.After 20 yearsof alcoholismhe joined A.A., and after 2 years of abstinence
soughtpsychotherapy. He describedhimselfas asexualand said both he and his wife found sexualactivity distasteful.However, after participating in some bisexualorgies,he began to wonder whether he could find a homosexual life satisfyingas, he says,his wife now does.
After 2• yearsof grouptherapyhe is still abstinentand sayshis life is 905 moreproductivethan duringdrinkingdays.He has had four homosexualexperiences in the past year and a half, but saysthat he finds A.A. Twelfth Step work and "gay"civil rights activitiesmore important and satisfyingthan any sexualexperiences. Case8. P.H., a third-generationSoutherner,referred himself at age 34 for treatment
for alcoholism. No known forebears were alcoholics.
Like his four heterosexualbrothers, the patient began drinking in a Methodistcollegeand, like them, was an alcoholicbefore graduation. All his sexualexperiences in collegewere homosexual, but he married a classmate who was a Roman Catholic
and was converted
to Cathol-
icism in the belief it would help him lead a heterosexuallife. He became an airline pilot and lived a heterosexuallife at home but away from home practicedhomosexuality.He believeshe drank to be able
to performhomosexual acts,then used his "queerness" as justification for more drinking. Periodic binges finally led to affiliation with A.A. He became abstinentimmediately, but 2 years later was divorced by his wife, who got custodyof their daughter.The patient then sought psychotherapy.He has now been abstinent40 months and is having a romancewith a fellow pilot. He sayssex still makes him feel sinful, but confession relieves him and he does not have to drink.
Case 9. H.H., a German-borngraduate student,was referred at age 25 by a physicianfor counselingfor alcoholism.His father was an alcoholic.
The patienthad workedhis way to this countryat age 15. He sayshe had alwaysbeen a heavy drinker and bisexual.In an East Coast university he had an affair with an older woman professor,but was a
"gay"activist.He beganto usedistilledspiritsand marihuana.A physician prescribedamphetamines,tranquilizersand barbiturates,and told H.Ho that homosexuality was the root of his drinkingproblem.Upon graduationhe becamea chef to supportfurther study. He was convincedthat the useof drugswas an integralpart of the "gaylifestyle," and frequentlywent to "gay"bars.After a nonproductive year of counselinghe was persuadedto enter a hospital for detoxication,then to spend a month in a rehabilitation center for alcoholics.He has now been abstinentfor 19 months,takes disulfiram and still usesmarihuana
g084
E.J. SMALL, JR. AND B. LEACH
but is discontented. He worksas a chef while pursuinggraduatestudies, but has not achieveda satisfyingsocialor sex life-that is, one which actualizeshis fantasies.He has recentlystartedgroup therapy.
Case10. R.T., son of a Jewishfather and an Italian mother,at age 55 was referredby his supervisorto his company'sprogramfor alcoholic employees.His motherhad died of alcoholism.
This patienthad begunboth pathological drinkingand homosexual experiences in high school.A technicalwriter, he liveswith his father in the house where his father was bon•. Before alcoholismcounseling
began,hislife had consisted onlyof xvork,barroomdrinking,homosexual experiences in movie theaters,and xvatchingtelevisionat home. He washospitalized whenhe was 35, 40 and 45 for "nervousbreakdowns," each following a painful encounterwith his homosexuality.He was certainit causedhis excessivedrinking.Probably the last two hospitalizationswere related in part to alcoholism,althoughit was not diagnosed. Referred to A.A., R.T. has now been abstinent for 29 months. All his friends and sexual liaisons are homosexual,but he insistshe is
not "oneof those."He has lately begunto professan interestin "gay" civil rights. DISCUSSION
None of the patientsdiscussed abovefits the stereotypeof the male homosexual.None had any urges to transvestism or transsexualism,or appeared in any way feminine. Most are in occupationsnot commonlyassociatedwith homosexuality,and none displayedthe motherfixationtraditionallyassociated with male homosexuality. Half of them had no knowledgeof parental alcoholism.Their personalitytypes varied widely, as did both their homosexualactivitiesand their drinking patterns. Nevertheless, a dim pattern seemsto emergefrom the casehistories.Thosewho were able to acceptand live comfortablywith the needfor abstinenceseemedalsomostlikely to achieverelatively successful sexualfunction(Cases1, 2, 3, 4, 7, 8, 10). Obversely, patientswho had cometo termswith their homosexuality seemed to find it easierto acceptthe diagnosis of alcoholismand the need for abstinence(Cases5, 6, 9). So the traditionalview that homosexualitycausesalcoholism,as in Case 1, may well be erroneous, even antitherapeutic.Recoveryfrom pathologicaldrinkingseemed to be within reach almostas soonas the patient could view alcoholismas a conditionindependentof homosexuality. At the least, thesehomosexualalcoholicsrespondedto treatment for alcoholism when the therapydid not demandthat they becomeheterosexual. "Gay"alcoholicswho insistthat the "basic"problemis homo-
COUNSELING HOMOSEXUAL ALCOHOLICS
2085
sexuality,as in Case2, may be trying to deflectattentionfrom the drinking-a denialtechnique,notedby Fox (24), which can postpone the startof abstinenceand recoveryfrom alcoholism. Sociallyconditionedfeelingsof discomfortabout sexualityare oftentroublesome to thesepeople,and reinforcementof suchfeelings by anyonewho becomesan "enabler"(25) can exacerbate the uneaseand help the patient avoid recognitionof alcoholism, since nearly all the alcoholicsdiscussedhere had used the fact of their homosexuality, or the "homosexual lifestyle,"as a rationalization for drinking. The 10 casesdescribedhere supportWeinberg's(26) contention that many problemsattributedto homosexuality are actually due to cultural traditionsand society'sreaction to perceivedhomosexuality.Suchproblemsseemto losemuch of their intensitywhen the homosexual's human environmentis not, in Weinberg's(26) term, '•homophobic." Probablythis was the casewhen many of thesepatientsfound themselves in the companyof other "gay" alcoholicsin A.A. The GeneralServiceOffice of A.A. now lists meetingsfor such alcoholicsin at least 15 cities in 3 countries 4 (although somehomosexualalcoholics preferto attendA.A. meetingsnot so segregated). In recent years The A.A. Grapevinehas carried casehistoriesof several recovered homosexualalcoholics,and A.A. World Services
hasjustpublished a pamphlet(27) containing suchan account.
REFERENCES
1. Wv.iNBv. a% M. S. and WInn•MS, C. J. Male homosexuals; their problemsand adaptations.New York; Oxford University Press;1974. 2. WEYGANI•T,W. PsychiatrischeBegutachtungbei Vergehen und Verbrechen in Amt eines degenerativ-homosexuellen Alkoholisten. Arch. KrimAnthrop. 17: 221-262,
1904.
3. NXcr•, P. Alkohol und Homosexualit•it. Allg. Z. Psycht. 68: 852-859, 1911. 4. DEuTscI-t,H. Alkohol und Homosexualit•it.Wien. klin. Wschr. 26: 102-103, 1913. 5. RingAnn,R. Homosexualityand alcoholism.Psychoanal.Rev. 10: 157-169, 1923.
6. Nv.v•u, P. Homosexualitbapparue tardivement sous l'infiuence d'excbs alcooliques.Ann. m•d.-psychol. 1072: 36-37, 1949. 7. FEra•NCZI,S. t3ber die Rolle der Homosexualit•itin der Pathogeneseder Paranoia. Jb. psychoanal.psychopath.Forsch. 3: 101-119, 1912. 8. Fv.ra•NCZI,S. Alkohol und Neurosen(Antwert auf die krilik Bleu}ers.) Jb. psychoanal.psychopath.Forsch. 3: 853-857, 1912. ' Personalcommunication,30 April 1976, from Box 459, New York, NY 10017.
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E. j'. SMALL, JR. AND B. LEACH
9. KNIGHT,R. P. The psychodynamics of chronicalcoholism.J. nerv. ment. Dis. 86: 538-548,
1937.
10. BERGLER, E. Contributionsto the psychogenesis of alcohol addiction. Quart. J. Stud. Alc. 5: 434-449, 1944. 11. FENICHEL, O. The psychoanalytic theoryof neurosis.New York; Norton; 1945. 12. RAn6, S. An adaptationalview of sexualbehavior.Pp. 159-169. In: HOCH,P. and ZuBIN, J., eds. Psychosocial developmentin health and disease.New York; Grune & Stratton; 1949.
13. BLUM, E. M. Psychoanalytic views of alcoholism;a review. Quart. J. Stud. Alc. 27: 259-299,
1966.
14. SAGHIR,M. T. and ROBBINS, E. Male and female homosexuality;natural history. Compr. Psychiat. 12: 503-510, 1971. 15. MAnSEN,W. The American alcoholic; the nature-nurture controversyin alcoholic researchand therapy. Springfield, IL; Thomas; 1974.
16. LANDIS,C. Theoriesof the alcoholicpersonality.Pp. 129-142. In: Alcohol, scienceand society;29 lectureswith discussions as given at the Yale Summer School of Alcohol Studies. New Brunswick, NJ; Journal of Studies on Alcohol; 1945.
17. QUARANTA, J. V. Alcoholism;a study of emotionalmaturity and homosexuality as related factorsin compulsivedrinking. Master'sthesis,Fordham University; 1947. 18. MACHOVER, S., Ptrzzo, F. S., MACHOVER, K. and PLUMEAU,F. Clinical and objective studiesof personality variables in alcoholism.HI. An objective studyof homosexuality in alcoholism.Quart. J. Stud. Alc. 20: 528-542, 1959. 19. McColm, W. and McColm, J. Origins of alcoholism.Stanford,CA; Stanford University Press; 1960.
20. PROUT,C. T., SamONGIN, E. I. and WHITE, M. A. A study of resultsin hospital treatment of alcoholismin males. Amer. J. Psychiat. 107: 14-19, 1950. 21. BOTWINICK, J. and MACHOVER, S. A psychometricexaminationof latent homosexualityin alcoholism.Quart. J. Stud. Alc. 12: 268-272, 1951. 22. GIBBINs,R. J. and WALTERS,R. H. Three preliminary studies of a psychoanalytic theory of alcoholism.Quart. J. Stud. Alc. 21: 618-641, 1960. 23. BARR,R. F., GREENBERG, H. P. and DALTON,M. S. Homosexualityand psychologicaladjustment.Med. J. Aust. 1: 187-189, 1974. 24. Fox, R. Treatmentof the problemdrinker by the private practitioner.Pp. 227243. In: BOURNE,P. G. and Fox, R., eds. Alcoholism;progressin research and treatment. New York; Academic; 1973. 25. KELLER•ANN,J. L. Alcoholism;a merry-go-roundnamed denial. New York; A1-AnonFamily Group Headquarters;1969. 26. WEINBERG,W. Society and the healthy homosexual.New York; St. Martin's Press; 1972. 27. Do you think you're different? New York; A.A. World Services; 1976.
Counseling Homosexual Alcoholics Ten
Case Histories
Edward J. Small,Jr? and Barry Leach, Ph.D? SVMM.•aY.The case historieso• 10 male homosexualalcoholicsare presented, and ps•tchoanal•tictheoriesabout the link between homosexualit•and alcoholism are reviewed.
WO MODERN STUDIES of homosexual men,discussed below,suggest a highincidence of alcoholism in thatpopulation. Our own clinicalexperience,moreover,is that almost one-thirdof the men seekingcounseling or treatmentfor alcoholism are concernedabout homosexuality. For at leasttwo reasons, it seemslikely that an increasingnumber of problem drinkersseekinghelp in the future will identify themselvesas homosexuals: growth of the "Gay Liberation"movement (1), and the AmericanPsychiatricAssociation's removal of homosexuality from its official list of mental illnesses. The case sketchesthat follow suggestthat homosexualityand alcoholism in menareprobablyindependentstates,and that homosexualityneed not be an obstacleto therapyor recoveryfrom alcoholism under certain conditions.
Homosexualityhas been linked to alcoholismor inebriety in theoreticalformulationsin the psychiatricand psychological literaturefor decades(2-6). Someof Freud'sreinterpreters,linking oral tendenciesto homosexuality, proposedthat the etiology of alcoholism is homosexuality. Ferenczi(7, 8) and Knight (9) saw in compulsivedrinkingan attempt to allay anxiety over masculine inadequacy,resultingfrom an overindulgentmother, traumatic weaning,the father'semotionalcoldness,and envy of the father's penis.Bergler (10) offereda similarformulation,noting that an • 99 East Fourth St., New York, NY 10003. .o100 Bank St., New York, NY 10014. Receivedfor publication: 22 February 1974. Revision: 2 March 1977. 2077
2078
v,. j-. S•'[ALL,JR. ANDB. LEACH
alcoholic'shomosexuality is latent. Abraham s held that oral frustration resultedin overidentificationwith the father, amounting to latent homosexuality,and that alcoholicscould expresstheir "deviant"urgesunder the influenceof alcoholwithin the "male" camaraderie of the saloon.Rad6 (12) declaredhomosexuality an irrationalfear of being heterosexual, presumablydissolvedby alcohol.In her extensivereviewof psychoanalytic viewsof alcoholism Blum (13) describedlove relationships established by an alcoholic as "supportingevidencefor an oral fixation or regression," but alsonoted that fixationat the anal stageoften resultsin "lovefor others, albeit of the same sex."
From many such formulations,it might be inferred that overt homosexuality avertsalcoholism,or that no one can manifestboth alcoholism andoverthomosexuality. The emphasis on oralityseems to define homosexuality almostexclusivelyas a drive to perform fellatio;noneof the theoriesaccountfor the frequencyof manual masturbation, anal intercourse, flagellationor any otherhomosexual (and heterosexual)practices,not to mentionobservableenduring marriage-typeor love relationsbetweenhomosexuals. Psychoanalytic assertions do not constitutehard evidence,of course,nor do they accountfor all homosexuals, repressedor overt, who do not become alcoholics,for all women homosexuals,for all women al-
cholics,for all heterosexual alcoholics, or for all "gay"male alcoholics who drink outside saloons.
As Saghirand Robbins(14), Madsen(15), and Weinbergand Williams (1) have noted,yearsof researchhave not led to agreement on either the definitionor the etiologyof homosexuality, or evenwhetherthere is indeedone suchcondition,personalitytype, or patternof behaviorwhich can be clearlydelineated.Neverthe-
less,someinvestigators havetried to determinein smallsamples whetherthereis an association betweenalcoholism and what they considerhomosexuality. Landis (16) comparedthe personalities of 29 drinkingand 25 remitted alcoholics and 21 nonalcoholic controls and found no re-
lationships betweenhomoeroticism and alcoholism; nor couldQuaranta (17) find sucha tie. Machoveret al. (18) reportedfinding what they judged to be homosexual "trends"more in evidence among29 drinkingalcoholics,but did not find the tendenciesmore prevalent among men alcoholicsthan among nonalcoholic,preCited in Fenichel (11).
COUNSELING HOMOSEXUAL ALCOHOLICS
2079
sumednonhomosexual, controls.McCord and McCord (19), in their longitudinalretrospectivestudy of alcoholics,found that "overtly homosexual" pubescentboys (N--6) were slightly more likely to becomealcoholics than"feminine"boys(thosewho playedwith dolls, expressedthe wish to be girls, or wore some feminine clothes),contradictingthe pseudo-Freudian contentionthat latent homosexuals have greater vulnerabilityto alcoholismthan overt ones.The McCords concludedthat their research"doesnot support the belief that alcoholicshave latently homosexualpersonalities"(19, p. 32). Prout et al. (20) found homosexuality in only 4 of 100hospitalizedmen alcoholics.Botwinickand Machover(21), having searchedfor homosexuality, latent or patent, in alcoholics, concludedthat "homosexuality cannot be an essentialfactor in alcoholism"(p. 272). Gibbinsand Walters (22) testedthe psychoanalytic theory that alcoholismis linked to repressedor latent homosexuality, using threeperceptual defenseexperiments on 179mensubiects , of whom 36 were manifesthomosexuals ("arrestedfor homosexual offenses") and 43 were patientsin an alcoholismclinic.The 100 controls,presumablyneither alcoholicnor prealcoholic,neither overtly nor covertly homosexual,were men who regularly attended YMCA (Young Men's ChristianAssociation) functions.Resultsof the first two experimentsdid not afford unequivocalsupportfor the tested theory,the authorsreported,and in the third, "responses of alcoholics were intermediate
between those of homosexuals and normal
subiects"( p. 640). So, althoughsexualidentity (not homosexuality qua homosexuality) canundoubtedly be a problemfor somealcoholics asfor some nonalcoholics,there is no clear evidence that alcoholism is caused
by homosexuality. Factorswhichproduceone may alsosometimes producethe other, but evidencefor this is also lacking. The only link or relationship betweenalcoholism and homosexuality may be their occasional occurrence within the same individual.
Nevertheless, two recent studiessuggestthere may be a relatively high incidenceof drinking-relatedproblemsamong.men homosexuals. AlthoughBarr et al. (23) concludedthat recentevidencefromstudiesof homosexuals who are not psychiatricpatients suggeststhat homosexuals are not more neuroticthan comparable
heterosexuals theyfoundproblemdrinkingamong30%of theirhomosexual population and in only20%of the heterosexual controls. Weinbergand Williams (1) studied2497 male homosexuals (1117
2080
E.J. SS•ALL,Ja. ANDB. LEACH
in the United States,1077in the Netherlands,and 303 in Denmark) and found no differencesin psychological problemsbetween the homosexual and generalpopulationsamples;they concludedthat sexualorientationis not necessarily correlatedwith psychological problems.But they alsonoted that 29.4%of their homosexual sample reported"drinkingmore than they should,"i.e., nearly "all the time"; another31.3%,"pretty often";and 30.4%reportedfrequentinga "gay"bar onceor more a week.Other Weinbergand Williamsfindingscould also correlatewith drinkingproblems,althoughno direct relationshipis shown.For example,subjectsreporting seeinga psychiatrist,sufferingfrom tremors, dizziness, nightmares, sweatyhands,guilt, depression, loneliness, job dissat-
isfactionand job changes couldbe revealingalcoholism. The followingcasehistoriesare believedto typify the coincidentaloccurrence of homosexuality in men in contemporary American culture.They appearto illustratethe hypothesisthat the two conditionsare most likely to coexistcircumstantially rather than causatively, but as they do not constitutea representative sample of either conditiontheir worth is only suggestive.The patients are all White men seenby us during a combinedtotal of 15 years of workingwith alcoholicsas an alcoholismcounselorin an industrial settingandin a programfor drinkingdrivers,andasa psychotherapistin privatepracticein association with a psychiatrist. CASES
Case 1. J.B., an American-bornman, presentedfor treatment at the age of 27. There was no family historyof alcoholism. He began experimentaldrinking and homosexualbehavior in high school,where he was an athletic star, continuingthrough 4 years of collegeand 2 of voicestudyin Italy, with occasional periodsof abstinence and continence.Alcoholismbecame severe during 3 years of professionalsingingin New York. He sought psychiatrictreatment, convinced that a mental disorder caused the homosexual behavior and
that this was at the root of his excessive drinking.During 3 years of grouptherapyhe resistedsuggestions to try AlcoholicsAnonymousand found homosexuality in himself or othersunacceptable.During times of abstinencehe refrained from sexualactivity, convincedhe would "getover"beinghomosexual, marry and havechildren.Failure to fulfill a professionalengagementbecauseof drunkenness persuadedhim to follow group adviceand concentrateon abstinenceby becomingan A.A. member.After a year of abstinencehe began to feel comfortable with other "gay"A.A. members,enteredinto a homosexualmarriagetype relationshipwith anotherA.A. member,and maintainedcontinuous
COUNSELING HOMOSEXUAL ALCOHOLICS
2081
abstinence. The relationship haslasted3J4years,and J.B. hasterminated psychotherapy.
Case 2. J.M., an American-bornJewishadvertisingwriter, at age 58 was referredby a countycourt to a rehabilitationprogramfor "drinking drivers."He reported that both his parentswere alcoholics. After 4 weeks in the court program,J.M. announcedthat he was a homosexual,not an alcoholic.Sexual activity with both men and womenhad begun at age 14 and continuedunabated after his marriage at age 21, which ended in divorce10 years later. At that time he had never drunk excepton ceremonialoccasions,but after the divorce he becamea heavy solitary drinker, isolatinghimself except during work hours and about once a month when he would get drunk and participate in homosexualorgiesat a Turkish bathhouse.He called himself a "fag baiter and beater"and took elaboratepainsto appear aggressively unattractive,masculineand hostile.He said he was stunnedby a counselor'ssuggestion that he might be both homosexualand alcoholic,both happy and sober."Beinghomosexual won't kill me, but drinkingwill," he finally announced.Highly intelligent and well motivated, he acceptedreferral to a psychotherapist in private practice,to A.A., and to
a "gay"socialclub in which he never developedany interest.After 6 monthsin the driver program, he was discharged.Two and a half yearslater he is still abstinent,active in A.A. (in both homosexualand heterosexualgroups), and sayshe leads a promiscuous "gay" sex life outsideA.A. He has terminatedpsychotherapy. In the last year he has had dramaticprofessional success. Case3. R.C., an American-bornRomanCatholicpriest of Italian parents,was referredfor counselingat age 42 by a priest friend after his third suicideattempt.His mother,a physician,becamean alcoholicin middle age. R.C. reportedbeing a heavy user of alcoholand tranquilizerssince
seminarydays.He speaksfive languages, hastwo doctoraldegreesand in his youth was considereda promisingfiction writer. He was infuriated by the suggestion of alcoholism, sayinghe drank only because of fury at the superiors of his orderxvhodeclinedto let him practice an openly"gay"ministry.He had read widely about alcoholism, about A.A. and about homosexuality. He insistedhe enjoyedbeing "gay," but admittedexperiencinglengthy depressions. He saw each sexual contact as the start of a sort of "betrothal" which was sure to lead to
"marriage,"which would in turn make his homosexualbehavior ac-
ceptable.He agreedreluctantlyto attend"gay"A.A. meetingswith another priest, also a homosexual alcoholic.Eight monthslater they formeda domesticpartnership, and R.C. left the priesthood to enter business. He hasnowbeenabstinent 28 months,is successful in a highly structuredcommercial enterprise,is writing fiction again and is active in A.A. He believeshis recoverybeganwhenhe couldacceptidentity first as an alcoholic, then as a homosexual. He believes he will even-
tually becomea communicant in his faith again.
2082
E.j.
SMALL, Ja. AND B. LEACH
Case 4. G.M., a New York-bornPuerto Rican, had begun recovery from alcoholism at age 36 with the aid of A.A. He saidhis father was a "reformed drunkard" who did not drink.
After 10 monthsof abstinenceG.M. soughtcounselingthrough his
employer's healthprogram because he had fallenin lovewith a fellow laborerand was deeplydepressed and 'fearfulthat he was a "queer." He had beena heavyuserof wine and beer in high school,but alcoholismwas not diagnoseduntil his foremanhad urged him to go to A.A. He had had sexualexperiences with many men and women,beginningin schooldays,but had been able to reachorgasmonlywith men. During the last 5 yearsof his alcoholism, however,he became impotentandsaidhe had decidedsexwashighlyoverrated in America. Abstinence had restoredhis potency.He first describedhimselfas "30g gay, 70g straight,"but after 8 monthsof counseling he reversedthe proportions. He is still abstinent, 5• yearsafter counseling terminated, and sayshe is contentwith a "gay"identitybut still unhappyat what he feels is the necessityfor hiding it. He sayshe used homosexuality as the excusefor heavy drinking. Case 5. M.S., an American-bornIrish•nan,at age 43 referred himself
to his company's alcoholism programat the urgingof A.A. friends. Orphanedin infancy,M.S. was reared by foster parentswho were prohibitionists. He wasabstinentuntil age 29, when he got drunkafter the break-upof his third engagement. His drinkinghas been periodic and pathologicalever since.He reportedbeing repeatedlyraped by an olderman in early childhood,and recallsno other sexualexperience exceptsolitarymasturbation until after he beganto drink,when he also begangoingto "gay"barsin a searchfor a homosexual lover,"in bitter resignation,"he said. This was revengefor the broken engagements, he feels.At 35 he enteredpsychiatrictreatment,and at 37 joined A.A. Until 8 monthsago he had never remained abstinentlonger than 2 months,alwaysgoing on a binge at the break-upof a "love affair." Eight monthsago, however,he began taking disulfiramdaily, and he now seemsdelightedthat he can have sexualexperienceswhile sober and without
emotional involvements. His attitude
toward A.A. has be-
come noticeablymore positive. Case 6. F.S., American-bornof German parents,referred himself for grouptherapyat age 37 after a year of sobrietyin A.A. There was no family history of alcoholism. F.S. began intensivehomosexualactivity and heavy drinking in college, but neither preventeda rapid rise to financial successon Wall Street.At 35, depressedabout failure to achieve any enduringhomosexuallove relationship,he entereda "gay" self-helpgroup.The group persuadedhim to go to A.A., but after a year'sabstinence he was still unhappy,complainingof hypoglycemia,which no medicalexamination could confirm, and of migraineheadaches.During 2J•years in group therapyhe has remainedabstinentand has begun to reassess his goals as a homosexual. He has becomea leader in the "Gay Liberation"move-
COUNSELINGHOMOSEXUAL ALCOHOLICS
2083
ment and is less concerned about so-called love affairs. He is active
in A.A. and his somaticcomplaintshave virtually disappeared. Case 7. J.P. referredhimselfat age 45 for outpatienttreatmentfor alcoholism.There was no family history of alcoholism. Born in Kansas,the patient began drinking while working for his doctoratein economics, shortlybeforemarryinga medicalstudent.After 20 yearsof alcoholismhe joined A.A., and after 2 years of abstinence
soughtpsychotherapy. He describedhimselfas asexualand said both he and his wife found sexualactivity distasteful.However, after participating in some bisexualorgies,he began to wonder whether he could find a homosexual life satisfyingas, he says,his wife now does.
After 2• yearsof grouptherapyhe is still abstinentand sayshis life is 905 moreproductivethan duringdrinkingdays.He has had four homosexualexperiences in the past year and a half, but saysthat he finds A.A. Twelfth Step work and "gay"civil rights activitiesmore important and satisfyingthan any sexualexperiences. Case8. P.H., a third-generationSoutherner,referred himself at age 34 for treatment
for alcoholism. No known forebears were alcoholics.
Like his four heterosexualbrothers, the patient began drinking in a Methodistcollegeand, like them, was an alcoholicbefore graduation. All his sexualexperiences in collegewere homosexual, but he married a classmate who was a Roman Catholic
and was converted
to Cathol-
icism in the belief it would help him lead a heterosexuallife. He became an airline pilot and lived a heterosexuallife at home but away from home practicedhomosexuality.He believeshe drank to be able
to performhomosexual acts,then used his "queerness" as justification for more drinking. Periodic binges finally led to affiliation with A.A. He became abstinentimmediately, but 2 years later was divorced by his wife, who got custodyof their daughter.The patient then sought psychotherapy.He has now been abstinent40 months and is having a romancewith a fellow pilot. He sayssex still makes him feel sinful, but confession relieves him and he does not have to drink.
Case 9. H.H., a German-borngraduate student,was referred at age 25 by a physicianfor counselingfor alcoholism.His father was an alcoholic.
The patienthad workedhis way to this countryat age 15. He sayshe had alwaysbeen a heavy drinker and bisexual.In an East Coast university he had an affair with an older woman professor,but was a
"gay"activist.He beganto usedistilledspiritsand marihuana.A physician prescribedamphetamines,tranquilizersand barbiturates,and told H.Ho that homosexuality was the root of his drinkingproblem.Upon graduationhe becamea chef to supportfurther study. He was convincedthat the useof drugswas an integralpart of the "gaylifestyle," and frequentlywent to "gay"bars.After a nonproductive year of counselinghe was persuadedto enter a hospital for detoxication,then to spend a month in a rehabilitation center for alcoholics.He has now been abstinentfor 19 months,takes disulfiram and still usesmarihuana
g084
E.J. SMALL, JR. AND B. LEACH
but is discontented. He worksas a chef while pursuinggraduatestudies, but has not achieveda satisfyingsocialor sex life-that is, one which actualizeshis fantasies.He has recentlystartedgroup therapy.
Case10. R.T., son of a Jewishfather and an Italian mother,at age 55 was referredby his supervisorto his company'sprogramfor alcoholic employees.His motherhad died of alcoholism.
This patienthad begunboth pathological drinkingand homosexual experiences in high school.A technicalwriter, he liveswith his father in the house where his father was bon•. Before alcoholismcounseling
began,hislife had consisted onlyof xvork,barroomdrinking,homosexual experiences in movie theaters,and xvatchingtelevisionat home. He washospitalized whenhe was 35, 40 and 45 for "nervousbreakdowns," each following a painful encounterwith his homosexuality.He was certainit causedhis excessivedrinking.Probably the last two hospitalizationswere related in part to alcoholism,althoughit was not diagnosed. Referred to A.A., R.T. has now been abstinent for 29 months. All his friends and sexual liaisons are homosexual,but he insistshe is
not "oneof those."He has lately begunto professan interestin "gay" civil rights. DISCUSSION
None of the patientsdiscussed abovefits the stereotypeof the male homosexual.None had any urges to transvestism or transsexualism,or appeared in any way feminine. Most are in occupationsnot commonlyassociatedwith homosexuality,and none displayedthe motherfixationtraditionallyassociated with male homosexuality. Half of them had no knowledgeof parental alcoholism.Their personalitytypes varied widely, as did both their homosexualactivitiesand their drinking patterns. Nevertheless, a dim pattern seemsto emergefrom the casehistories.Thosewho were able to acceptand live comfortablywith the needfor abstinenceseemedalsomostlikely to achieverelatively successful sexualfunction(Cases1, 2, 3, 4, 7, 8, 10). Obversely, patientswho had cometo termswith their homosexuality seemed to find it easierto acceptthe diagnosis of alcoholismand the need for abstinence(Cases5, 6, 9). So the traditionalview that homosexualitycausesalcoholism,as in Case 1, may well be erroneous, even antitherapeutic.Recoveryfrom pathologicaldrinkingseemed to be within reach almostas soonas the patient could view alcoholismas a conditionindependentof homosexuality. At the least, thesehomosexualalcoholicsrespondedto treatment for alcoholism when the therapydid not demandthat they becomeheterosexual. "Gay"alcoholicswho insistthat the "basic"problemis homo-
COUNSELING HOMOSEXUAL ALCOHOLICS
2085
sexuality,as in Case2, may be trying to deflectattentionfrom the drinking-a denialtechnique,notedby Fox (24), which can postpone the startof abstinenceand recoveryfrom alcoholism. Sociallyconditionedfeelingsof discomfortabout sexualityare oftentroublesome to thesepeople,and reinforcementof suchfeelings by anyonewho becomesan "enabler"(25) can exacerbate the uneaseand help the patient avoid recognitionof alcoholism, since nearly all the alcoholicsdiscussedhere had used the fact of their homosexuality, or the "homosexual lifestyle,"as a rationalization for drinking. The 10 casesdescribedhere supportWeinberg's(26) contention that many problemsattributedto homosexuality are actually due to cultural traditionsand society'sreaction to perceivedhomosexuality.Suchproblemsseemto losemuch of their intensitywhen the homosexual's human environmentis not, in Weinberg's(26) term, '•homophobic." Probablythis was the casewhen many of thesepatientsfound themselves in the companyof other "gay" alcoholicsin A.A. The GeneralServiceOffice of A.A. now lists meetingsfor such alcoholicsin at least 15 cities in 3 countries 4 (although somehomosexualalcoholics preferto attendA.A. meetingsnot so segregated). In recent years The A.A. Grapevinehas carried casehistoriesof several recovered homosexualalcoholics,and A.A. World Services
hasjustpublished a pamphlet(27) containing suchan account.
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3. NXcr•, P. Alkohol und Homosexualit•it. Allg. Z. Psycht. 68: 852-859, 1911. 4. DEuTscI-t,H. Alkohol und Homosexualit•it.Wien. klin. Wschr. 26: 102-103, 1913. 5. RingAnn,R. Homosexualityand alcoholism.Psychoanal.Rev. 10: 157-169, 1923.
6. Nv.v•u, P. Homosexualitbapparue tardivement sous l'infiuence d'excbs alcooliques.Ann. m•d.-psychol. 1072: 36-37, 1949. 7. FEra•NCZI,S. t3ber die Rolle der Homosexualit•itin der Pathogeneseder Paranoia. Jb. psychoanal.psychopath.Forsch. 3: 101-119, 1912. 8. Fv.ra•NCZI,S. Alkohol und Neurosen(Antwert auf die krilik Bleu}ers.) Jb. psychoanal.psychopath.Forsch. 3: 853-857, 1912. ' Personalcommunication,30 April 1976, from Box 459, New York, NY 10017.
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9. KNIGHT,R. P. The psychodynamics of chronicalcoholism.J. nerv. ment. Dis. 86: 538-548,
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10. BERGLER, E. Contributionsto the psychogenesis of alcohol addiction. Quart. J. Stud. Alc. 5: 434-449, 1944. 11. FENICHEL, O. The psychoanalytic theoryof neurosis.New York; Norton; 1945. 12. RAn6, S. An adaptationalview of sexualbehavior.Pp. 159-169. In: HOCH,P. and ZuBIN, J., eds. Psychosocial developmentin health and disease.New York; Grune & Stratton; 1949.
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14. SAGHIR,M. T. and ROBBINS, E. Male and female homosexuality;natural history. Compr. Psychiat. 12: 503-510, 1971. 15. MAnSEN,W. The American alcoholic; the nature-nurture controversyin alcoholic researchand therapy. Springfield, IL; Thomas; 1974.
16. LANDIS,C. Theoriesof the alcoholicpersonality.Pp. 129-142. In: Alcohol, scienceand society;29 lectureswith discussions as given at the Yale Summer School of Alcohol Studies. New Brunswick, NJ; Journal of Studies on Alcohol; 1945.
17. QUARANTA, J. V. Alcoholism;a study of emotionalmaturity and homosexuality as related factorsin compulsivedrinking. Master'sthesis,Fordham University; 1947. 18. MACHOVER, S., Ptrzzo, F. S., MACHOVER, K. and PLUMEAU,F. Clinical and objective studiesof personality variables in alcoholism.HI. An objective studyof homosexuality in alcoholism.Quart. J. Stud. Alc. 20: 528-542, 1959. 19. McColm, W. and McColm, J. Origins of alcoholism.Stanford,CA; Stanford University Press; 1960.
20. PROUT,C. T., SamONGIN, E. I. and WHITE, M. A. A study of resultsin hospital treatment of alcoholismin males. Amer. J. Psychiat. 107: 14-19, 1950. 21. BOTWINICK, J. and MACHOVER, S. A psychometricexaminationof latent homosexualityin alcoholism.Quart. J. Stud. Alc. 12: 268-272, 1951. 22. GIBBINs,R. J. and WALTERS,R. H. Three preliminary studies of a psychoanalytic theory of alcoholism.Quart. J. Stud. Alc. 21: 618-641, 1960. 23. BARR,R. F., GREENBERG, H. P. and DALTON,M. S. Homosexualityand psychologicaladjustment.Med. J. Aust. 1: 187-189, 1974. 24. Fox, R. Treatmentof the problemdrinker by the private practitioner.Pp. 227243. In: BOURNE,P. G. and Fox, R., eds. Alcoholism;progressin research and treatment. New York; Academic; 1973. 25. KELLER•ANN,J. L. Alcoholism;a merry-go-roundnamed denial. New York; A1-AnonFamily Group Headquarters;1969. 26. WEINBERG,W. Society and the healthy homosexual.New York; St. Martin's Press; 1972. 27. Do you think you're different? New York; A.A. World Services; 1976.
