Ms. Tseng, who began drinking when she was 16, drank four or five bottles of deer antler wine on the day before she finally decided to quit. She describes her feelings toward alcohol as like being in love, with drinking the only way to deal with the pain of longing. In this way, each day she began to drink earlier and earlier, and her drinking capacity declined steadily, until she ended up being "sloshed" all day every day, and lost everything. "I knew I was in trouble, but I didn't know where to turn. The help offered by religion, hotlines, and psychology was like trying to put out a blazing fire with a thimbleful of water. Finally I checked into the psychiatric ward, and a doctor told me that after leaving hospital I would have to rely on my own will power."

Fortunately, five years ago she joined Alcoholics Anonymous (AA): "Giving up drinking is a lifetime task, and I am relying on this group to prevent a recurrence of my addiction to alcohol."

Every evening when the working day is over, there are countless people like Ms. Tseng, hidden in every corner of society, struggling against alcohol. They don't dare drop their guard for an instant. Thirty-plus members of AA hold regular meetings at Taiwan Adventist Hospital, Taipei City Psychiatric Center, Mackay Memorial Hospital, or at sites in Tienmu and Taoyuan. They even meet on Saturdays and Sundays. There's only one reason why these people will brave any weather and invest nearly all their leisure time in gathering together-to stay sober.

The cry of the alcoholic

"My name is Chen, I am an alcoholic. Every time I drink, I fail. In my heart I only have one thought: I imagine that I can consume alcohol like normal people. But when I drink I end up laying around all day, completely intoxicated. My friends and my family have left me one by one. Though drinking was painful, I used drinking to face up to problems. Whether I was in a celebratory, angry, sad, or happy mood, I always thought it a reason to drink, and once I began drinking I couldn't stop. Family members helped me find religious groups and doctors, but these had no effect. Finally, on the edge of death, I fortunately was able to find in AA a method to keep me off alcohol."

"My name is Pan, I am an alcoholic. Others can drink, why can't I? I always want to go back to those days when drinking was a happy thing. In fact, I never believed that I was alcoholic, and always thought that I really wasn't so badly off. But, because I was always in and out of the hospital or praying to god because of alcohol, other people came to despise me more and more. Still, it was only when I began to tremble, sweat profusely, and even lose control of my basic bodily functions that I realized that I was an alcoholic beyond saving."

Through reading and sharing, the members of AA, who all recognize themselves as alcoholics, lend each other moral support in their struggle to keep their distance from alcohol.

Fatal attraction

What is the definition of addiction to alcohol? Why is it that some people become addicted and cannot stop?

Chen Chiao-chi, director of the department of psychiatry at the Taipei City Psychiatric Center, says that sufferers of alcohol addiction (also called alcohol abuse or alcohol dependence) cannot control their desire to drink, and once they begin they cannot stop.

Generally speaking, the following three indicators tell you whether the person you observe is alcoholic: First, whenever alcoholics stop drinking, they show withdrawal symptoms, including trembling, profuse sweating, nausea, cramps, and visual and auditory hallucinations. Secondly, alcoholics have declining social and professional skills. They are unable to work, their quality of life declines, and they become focused entirely on finding something to drink. Third, alcoholics repeatedly quit and start again.

Why do some people become addicted to alcohol, whereas most people do not? Even to the present day, the causes of alcoholism are not entirely clear, and it probably involves interaction between inherited and environmental factors. Still, Chen Chiao-chi says, in 80% of cases the main factor is genetic, whereas in about 20% the main causes are environmental.

Chiang Han-kuang of the Shutien Clinic says that medical research indicates that most alcoholics have latent psychological or personality problems. Alcohol becomes for them an easily accessible and fatally attractive tool to balance their moods. Alcoholism thus becomes the surface expression of, and behavioral escape from, the symptoms of their psychological case.

The incidence of alcoholism is about 1.5% in Asia, whereas it is as high as 25% in the West. The large difference between East and West is mainly due to the fact that there are differences among the body's enzymes that process alcohol, differences that vary with race.

As Chen Chiao-chi explains, the liver breaks down alcohol in two steps. First, alcohol dehydrogenase turns the alcohol into acetaldehyde. Then aldehyde dehydrogenase converts the acetaldehyde into acetic acid, which is converted into water and carbon dioxide and expelled from the body.

Research indicates that about 50% of persons of East Asian ancestry lack the gene which allows the liver to manufacture aldehyde dehydrogenase, so that acetaldehyde accumulates in the body, causing a number of uncomfortable symptoms including redness in the face, dizziness, vomiting, and sweating.

This "protective coloring" of greater sensitivity to alcohol in fact greatly reduces the incidence of alcohol dependence among people of Asian ancestry. In this context, it is worth noting that the high incidence of alcoholism among Taiwan's aboriginal people, similar to the incidence among people of European ancestry, is due to the fact that aboriginal people, like Europeans, lack this "protective mechanism."

I'm not doing it on purpose

For alcoholics, the only way to stay sober is to not drink-not a single drop.

Chen Chiao-chi points out that many studies have explored the questions of whether alcoholics can ever relearn to drink moderately, or can recover the ability to control their consumption. The results always suggest that this is impossible.

In order to avoid any temptations to consume alcohol, Ms. Tseng tells her friends: "If I drink anything at all I may have a heart attack, so you have to send me to the emergency room." She is not exaggerating. It is quite common for alcoholics to drink to the point where they need emergency medical treatment.

A blood-alcohol level of less than 0.2% is the "slight intoxication" stage. At this time there are early signs of intoxication, such as talkativeness and mild euphoria. A blood-alcohol level of 0.2%-0.3% is the "excitement" stage, in which the individual becomes even more voluble and unsteady on his feet. In the "disturbed" stage, at 0.3%-0.4%, the individual is now drunk, is unable to speak clearly or coherently, and cannot walk a straight line. With a blood-alcohol level over 0.4%, at the "irrational" stage, the individual is severely drunk, cannot distinguish direction, talks nonsense, and loses the ability to reason. Anything above 0.5% indicates severe intoxication, with impaired consciousness, labored breathing, and possible death.

Unfortunately, few alcoholics think of themselves as ill. Indeed most people in society see heavy drinking as a "bad habit" or "unedifying hobby," not realizing that it is an illness. Even the national health insurance program does not cover the costs of treatment for alcohol dependency. Chen Chiao-chi says that given these social parameters, by the time most alcoholics get to psychiatric departments for treatment, they have been drinking for 10 to 15 years. "Alcoholics who come to the hospital are, on average, 39.4 years old, and the average age of death is 43.6. You can see that they already are in the later stages of their disease by the time they seek treatment." Most alcoholics miss the opportunity to catch and treat their disease early, so the death rate is very high.

He says that long-term unrestrained drinking can lead to gastrointestinal and liver disorders, cardiovascular disease, high blood pressure, cancer of the liver, lungs, or pancreas and other complications; there is also an increased risk of accidents.

In addition, long-term drinking can cause serious damage to the nervous system. When the brain is soaked in alcohol, nerve cells shrivel and both structure and function can show irreversible degenerative diseases. Sufferers can display trembling of the hands and palpitations of the heart, jealousy, delusions, auditory and visual hallucinations, anxiety, and decline of reasoning faculties.

Trust me, You can make it!

By this stage, treatment for alcoholism requires not only medication to reduce the desire for alcohol or to hinder the process that breaks alcohol down (so that consuming alcohol causes immediate discomfort), but also psychological counseling, to strengthen the motivation of the alcoholic to recover.

But how many people can escape drowning in the sea of booze, even with treatment? The answer is not very hopeful.

According to a follow-up study by Chen Chiao-chi and others of patients who have been to their hospital for treatment, two years after treatment 14% were completely off alcohol, another 28% were still alcohol dependent, and 22% were dead.

While some people have gone for help to medical institutions, others have turned to the power of religion or of "support groups" in which patients lend each other moral support. The most well known of these latter groups is Alcoholics Anonymous (Al-Anon or AA).

AA is a global organization, with an estimated 90,000-plus chapters in more than 140 countries. AA has been in Taiwan for nearly a decade. Anyone who wants to stop drinking is welcome to join at any time, and will be invited to embrace the Al-Anon recovery program.

The AA recovery plan suggests 12 steps, based on the experience of the earliest Al-Anon members, who "admitted we were powerless over alcohol," "came to believe that a power greater than ourselves could restore us to sanity," "made a searching and fearless moral inventory of ourselves," and "humbly asked God to remove our shortcomings." These steps look easy enough on paper; can they really help people quit?

"I have been helped by the power of shared experience," says Mr. Lu, who has been in AA for five or so years and has been "dry" for the same period of time. "In helping others you also remind yourself of what you need to remember, and in the experiences of others you can find hope."

A lifetime assignment

"Family members ask me: 'You have already stopped drinking for quite a while. When will you no longer need to go to AA?'" says Ms. Tseng. Her answer is that although right now she is not drinking, by no means has she rid herself of her addiction.

Staying sober is a lifetime assignment for every alcoholic. "The thing that most troubles us is fear," says Mr. Lu. Alcoholics are always afraid to face the past, and lack confidence in the future.

Currently, Taiwan society offers little help to alcoholics. AA is not a compulsory organization, Taiwan has no mandatory "drying out" institutions, and there are no statistics on how many hidden alcoholics there may be.

If society were to offer more understanding and concern, and less temptation and blame, perhaps it could give alcoholics a little more confidence and courage on their long road to recovery.

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Illustrations for this article were done by cartoonist Chang You-cheng. His best known works include the humorous Twisted Idioms and Slang Sandwich.