GIG.8G i PlG < 3 & ALCOHOLIC PSYCHOSES BEFORE AND AFTER PROHIBITION -BY- HORATIO M. POLLOCK, Ph. D. Statistician and Editor, New York State Hospital Commission Albany, N. Y. Reprinted from “THE STATE HOSPITAL QUARTERLY,” November, 1922 iy 4i J § CT/ vA \ L i i V, k yjp \ z. A/ $ u/ A- TM ^0 ^ % \ J \c ^?T \-P L V cr \ \ Yl \ \ \ ' ? ' A i \ \ A A \ INDEX NUMBER 110 100 90 80 70 60 50 40 30 20 19 14 10 1009 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 YEARS ( Table 5. First Admissions with Alcoholic Psychoses to Massachusetts State Hospitals for Mental Disease and McLean Hospital , 1912-1921 Alcoholic First Admissions Per cent* of Year Number total first admissions 1912 301 11.3 1913 367 11.8 1914 311 10.4 1915 299 9.5 1916 289 9.1 1917 511 12.3 1918 304 8.1 1919 296 7.8 1920 102 3.6 1921 151 4.9 The number of cases among all first admissions in which there is a record of intemperate use of alcohol shows a corresponding decline during the same period in both New York and Massachusetts. The data for New York State are given in Table 6 : Table 6. Intemperate Use of Alcohol Among First Admis- sions, New York Civil State Hospitals, 1909-1921 Intemperate Users of Alcohol Per cent of Number total first admissions Year Males Females Total Males Females Total 1909 1,229 369 1,598 44.2 15.1 28.7 1910 1,684* 488* 2,172* 56.9 28.7 38.1 1911 1,082 302 1,384 35.9 11.2 24.3 1912 1,097 273 1,370 36.5 10.0 23.8 1913 1,103 318 1,421 34.6 11.1 23.5 1914 1,027 258 1,285 30.8 8.8 20.5 1915 939 225 1,164 28.8 7.5 18.7 1916 t 725 182 907 28.2 7.8 18.5 1917 1,152 300 1,452 32.0 9.2 21.1 1918 851 253 1,104 24.1 7.7 16.2 1919 804 161 965 22.8 4.9 14.2 1920 684 119 803 20.3 3.7 12.2 1921 691 131 822 18.9 4.0 11.8 * Includes moderate drinkers, t Nine months. 8 The gradual decline in the excessive use of alcohol indi- cated by the above table constitutes good evidence that a marked change in the habits of the general population with respect to the use of alcohol had been taking place for several years prior to the enactment of the Volstead Law. The change began before the World War, but was halted by the reaction of 1917. Later it was accelerated by war- time restrictions. Alcoholic Admissions in 1921 The following tables, compiled by Miss Edith M. Furbush, Statistician of The National Committee for Mental Hygiene, from original standardized reports of state hospitals, give the latest available data concerning the prevalence of alco- holic psychoses in various parts of the country: Table 7. Alcoholic Psychoses Among First Admissions to State Hospitals in Fourteen States , 1921 Alcoholic First Admissions State Total first admissions Number Per cent of all first admissions California 2,459 110 4.5 Colorado 457 4 0.9 Maine 399 17 4.3 Massachusetts 2,538 130 5.1 New Hampshire 260 12 4.6 New Jersey 1,301 28 2.2 New York 7,104 210 3.0 Ohio 2,838 61 2.1 Pennsylvania 1,508 39 2.6 Ehode Island 329 19 5.8 South Carolina 740 9 1.2 South Dakota 193 1 0.5 Vermont 140 3 2.1 Virginia 1,315 24 1.8 Total 21,581 667 3.1 These representative data show that only 3.1 per cent of first admissions to state hospitals in 1921 were cases of alcoholic psychoses. Compared with figures previously given from the Federal Census of 1910 and the reports of 9 the New York State Hospital Commission, a marked general decline in alcoholic insanity is shown. This is further evidenced by the data of all admissions shown in Table 8, which is on nearly the same basis as the Federal Census figures : Table 8. Alcoholic Admissions to State Hospitals in Four- teen States Compared with All Admissions and General Population, 1921 Rate All Alcoholic Admissions per 100,000 State Total admissions Number Per cent of all admissions of general population California 3,098 133 4.3 3.8 Colorado 480 5 1.0 0.5 Maine 20 4.1 2.6 Massachusetts 3,349 174 5.2 4.5 New Hampshire 301 14 4.7 3.2 New Jersey 38 2.4 1.2 New York 9,235 255 2.8 2.4 Ohio 3,539 77 2.2 1.3 Pennsylvania 47 2.7 0.5 Rhode Island 413 24 5.8 3.9 South Carolina 938 10 1.1 0.6 South Dakota 256 1 0.4 0.2 Vermont 197 3 1.5 0.9 Virginia 1,597 30 1.9 1.3 Total 27,178 831 3.1 1.9 It will be noted that the rate of admissions with alcoholic psychoses in these states was only 1.9 per 100,000 popula- tion, as compared to 6.7 for the whole country in 1910. During the year 1920, the first year under prohibition, alcoholic admissions to state hospitals were less than in 1921. 10 Table 9 . Prevalence of Alcoholic Psychoses in Twenty States, 1919-1921 I Number of Alcoholic ^irst Admissions per Rate of Alcoholic First Admissions 100,000 of Population State 1921 1920 1919 1921 1920 1919 Arizona * 3 * 0.9 Arkansas * 8 5 * 0.5 0.3 California 110 * * 3.1 * * Colorado 4 1 2 0.4 0.1 0.2 Connecticut * * 31 * * 2.3 Georgia * 9 9 * 0.3 0.3 Iowa * 20 26 * 0.8 1.1 Maine 17 6 18 2 . 2 0.8 2.4 Massachusetts . . 130 91 295 3.3 2.4 7.8 Nebraska * * 6 * * 0.5 New Hampshire.. 12 12 16 2.7 2.7 3.6 New Jersey .... 28 27 * 0.9 0.9 * New' York 210 143 285 2.0 1.4 2.8 Ohio 61 64 * 1.0 1.1 * Pennsylvania . . . 39 * * 0.4 * * Rhode Island . . . 19 14 19 3.1 2.3 3.2 South Carolina. . . 9 5 6 0.5 0.3 0.4 South Dakota .... 1 o 0.2 0.3 Vermont 3 2 2 0.9 0.6 0.6 Virginia * Data not available. 24 21 30 1.0 0.9 1.3 Table 9 gives comparative data for several states for 1919, 1920, and 1921. Although the table is incomplete, it shows considerable reduction in alcoholic admissions in several states from 1919 to 1920 and an increase from 1920 to 1921. The reaction in 1921 may be due to lax enforcement of liquor laws or perhaps in part to the economic depression. 11 Table 10. Sex of First Admissions ivith Alcoholic Psychoses in Twenty States , 1919-1921 1921 1920 1919 State Males Females Total Males Females Total Males Females Total Arizona * * * 3 3 Arkansas * * * 8 8 5 5 California 102 8 110 * * * * * * Colorado 3 1 4 1 1 2 2 Connecticut .... * * * * * * 27 4 31 Georgia * * * 8 1 9 9 9 Iowa * * * 20 20 25 1 26 Maine 16 1 17 6 6 17 1 18 Massachusetts . . 102 28 130 78 13 91 241 54 295 Nebraska * * * * * *5 f 6 6 New Hampshire 9 Q 12 12 12 15 1 16 New r Jersey. . . . 25 3 28 25 2 27 * * * New York 184 26 210 110 33 143 216 69 285 Ohio 57 4 61 60 4 64 * * * Pennsylvania . . 34 5 39 * * * * * * Rhode Island . . 17 2 19 11 9 14 17 2 19 South Carolina.. 9 9 5 5 6 6 South Dakota . . . 1 1 2 2 Vermont 2 1 3 1 1 2 2 9 Virginia 22 2 24 18 3 21 27 Q 30 * Data not available. 2 See note, p. 5. Table 10 shows the sex distribution of the alcoholic first admissions in the several states. Kelatively the decline in female alcoholic first admissions in 1920 and 1921 was more than in male cases. These results correspond with those found by Miss Stoddard 2 in her study of the effects of pro- hibition among women. She states : 4 4 The women have apparently gained more than the men under prohibition, perhaps because they are less exposed to the bootleggers’ blandishments and are less likely to seek out the tribe. At all events, the average number of women in all penal insti- tutions of Massachusetts on September 30, 1920 and 1921, the two dry years, was the lowest of the decade, 60 per cent smaller than the wet years’ average, while the total prison population on this date had dropped 52 per cent. 44 A decrease of practically one-half in the number of 12 coimnitments to the State Reformatory for Women in the two prohibition years carries a stage farther the story, not only of the passing of the alcoholic women from penal in- stitutions, but also of other women offenders.” Environment of Alcoholic Cases During the entire period for which we have adequate data, alcoholic psychoses have been much more prevalent in urban than in rural districts. As previously mentioned, in 1910 the rates of all alcoholic admissions in the United States per 100,000 of general population of the same en- vironment were 10.7 and 2.6 respectively. The admissions from urban districts in that year constituted 77.8 per cent of all the alcoholic admissions. Since 1910, the proportion of alcoholic cases from urban districts has increased. In a study 3 of first admissions to the New York civil state hospitals from July 1, 1915, to June 30, 1920, it was found that 90.9 per cent of the alcoholic first admissions were from urban districts. The average annual rate per 100,000 of general population was 3.7 in urban districts and 1.6 in rural districts. Representative data compiled by Miss Furbush from state-hospital reports of several states in 1919, 1920, and 1921, show the following percentages: Table 11. Environment of First Admissions with Alcoholic Psychoses , 1919-1921 (Representative data compiled from state-hospital reports of several states) Urbax Rural Year Number Per cent Number Per cent 1919 333 85.6 56 14.4 1920 400 83.9 77 16.1 1921 622 84.4 115 15.6 As the number and location of the state hospitals report- ing were not identical in the three years, the above data are not strictly comparable, but indicate clearly the preponder- ance of cases of alcoholic psychoses in urban districts. 3 Mental Diseuse in ('ities, Villages, and Rural Districts of Neio York, 1915-1920, by- Horatio M. Pollock and William J. Nolan. State Hospital Quarterly, November, 1921, Vol. 7, pp. 38-65. 13 Conclusions 1. Marked reduction in the prevalence of alcoholic psy- choses throughout the United States has taken place since 1910. This is due partly to restrictions on the liquor traffic and partly to changes in the habits of the people. 2 . The lowest rate of first admissions with alcoholic psy- choses occurred in 1920; a reaction occurred in 1921. 3 . The rate of alcoholic first admissions is closely corre- lated with the per capita consumption of liquors. 4. The reduction in the rate of alcoholic psychoses has been relatively greater among women than among men. 5. Admissions with alcoholic psychoses come principally from urban districts. r