Can they be helped? A PUBLIC WELFARE EXPERIMENT IN THE TREATMENT OF ALCOHOLICS 
TABLE OF CONTENTS 
Page 
1. Why Portal House? 4 
2. Dependent Alcoholics 4 
3. Advisory Committee 4 
4. Staff and Physical Set-up 4 
5. Selection o£ Patients 6 
(3. Conception of Treatment 6 
7. Treatment Plan , g 
8. Individual Counseling ____ 7 
9. Group Counseling 7 
10. Psychological, Psychiatric and Other Services..... 8 
11. Work and Recreation 9 
12. Self Government 9 
13. Nutrition 10 
14. Follow-up Care ... 11 
15. Results 11 
16. Definitions and Analysis of Patient Group 11 
17. Classification of Patients 12 
18. Adjustment of Patients to Resident Treatment 13 
19. Physical Condition of Patients 14 
20. Response to Treatment 15 
21. Earning Capacity Lost by Patients Through Excessive Drinking 15 
22. Psychological Analysis of Patient Group Personality Patterns, Intelligence 
and Related Factors for Group of 83 Patients; Personality Changes Dur- 
ing Residence 16 
23. Comparative Cost of Experiment.. 17 
24. Advisory Committee Membership. 18 
DEPARTMENT OF WELFARE 
1948 
CITY OF CHICAGO rT''HIS IS THE STORY OF PORTAL HOUSE-a 
new-type treatment center for alcoholics set up by 
the Chicago Department of Welfare as an experiment 
on June l(i, 1947. 
It is a heartening story. Results achieved were far 
beyond expectations. 
At the conclusion of the experiment—one year from 
the date it began—Portal House, with all of its fa- 
cilities and staff, was turned over to the Chicago 
Committee on Alcoholism, a private, non-profit or- 
ganization, in order that its doors might be opened 
not only to paupers but to the many persons in Chi- 
cago in need and able to pay a nominal fee for the 
kind of help it offered. 
During its brief existence as a public welfare proj- 
ect, Portal House proved conclusively that something 
can be done to help impoverished alcoholics become 
again self-supporting and respected members of the 
community. 
Portal 
House Why Portal House? 
In the first scientific study on the extent of alco- 
holism in major U. S. cities1 the number of excessive, 
uncontrolled drinkers in Chicago was estimated to be 
over 100,000, most of whom were in need of treatment; 
more than 26,000 of these were chronic alcoholics, (i.e. 
they had been damaged mentally and/or physically by 
excessive use of alcohol) .2 
Data for this estimate were obtained from first 
admissions to hospitals, from autopsy and diagnostic 
records and similar sources. About 80% of all cases 
sent to Chicago’s lock-ups involved alcoholism. Be- 
tween 4,000 and 5,000 persons handled monthly by the 
Municipal Courts in Chicago came to the attention 
of the court because of misconduct while inebriated. 
In 1946, 27% of all admissions to Cook County Psycho- 
pathic Hospital were cases of chronic alcoholics. 
Despite this alarming situation, no comprehensive 
treatment facilities existed in Chicago. 
Dependent Alcoholics 
These conditions in the community were reflected 
to a very noticeable degree in the caseload of the 
Department of Welfare. The Department’s Medical 
Review Unit, conducting physical examinations of 
recipients and applicants, reported diagnosis of 3 to 
5 cases of alcoholism daily, of which 1 to 2 cases ap- 
peared good prospects for treatment effort. 
Case histories in the files of the Department pointed 
to alcoholism as a source of many misfortunes: break- 
downs of family life, tragic economic and human 
waste, incalculable costs to the community. 
The Department provides medical, dental and psy- 
chiatric services for all recipients who are in need. 
These services include facilities for diagnosis, treat- 
ment, prevention, nursing and convalescence. Con- 
vinced that alcoholics were sick people, the Depart- 
ment decided that they should be similarly treated. 
Advisory Committee 
In setting up Portal House, the Department sought 
the advice of nationally recognized experts. An Ad- 
\4sory Committee was formed whose membership com- 
prised physicians, psychologists, sociologists, and social 
workers. The Committee was headed by Dr. Anton J. 
Carlson, eminent University of Chicago physiologist, 
and President of the Research Council on Problems 
of Alcoholism (an affiliate of the National Research 
Council), and Dr. Andrew C. Ivy, Vice President in 
charge of professional schools of the University of 
Illinois.3 
Staff and Physical Set-Up 
The Portal House staff consisted of a Director and an 
assistant, both of whom were arrested alcoholics and 
experienced in counseling; three counselors (non- 
alcoholics) ; one psychologist; one part-time psychia- 
trist (loaned by Illinois Neuropsychiatric Institute); 
one part-time physician; one part-time vocational 
counselor; an office manager and a stenographer. 
Cooperating with Portal House in a consultative 
capacity were staff members from several divisions of 
the Department of Welfare. These included a case 
worker assigned to handling patients’ social and 
family problems; a home economist to conduct classes 
on nutrition and food preparation; specialists and 
counselors in work therapy and occupational place- 
ment. 
Members of Alcoholics Anonymous, former patients 
and clergymen of Lutheran, Catholic and Episco- 
palian faiths volunteered their services in many useful 
capacities. 
Portal House was located on the third floor, north 
wing of the Department’s Convalescent Home at 5059 
South Vincennes Avenue. It had a capacity of 22 pa- 
tients. Quarters consisted of a large dormitory—light, 
airy and spacious; ample bath and toilet facilities; a 
comfortably furnished living and dining room; pri- 
vate rooms for interviewing purposes; a conference 
room used for classes and discussions; an office; living 
quarters for resident staff. 
Patients were provided reading and writing mate- 
rials, including non-technical publications relating to 
alcoholism and current periodicals. A ping-pong table, 
games and radio provided recreational outlets. Com- 
mon eating and Jiving room offered opportunities for 
close and constant community between staff and 
patients. 
Minimal rules were established for patients’ guid- 
ance and observance. The very nature of the program 
required an informal atmosphere in which patients 
were to live without self-consciousness and without a 
sense of strict supervision. They willingly assumed 
responsibility, through self-government, for mainte- 
nance of the premises and the garden, and for admin- 
istering needed discipline in their own group. 
1E. M. Jellonick, SCI), “Recent Trends in Alcoholism and 
Alcohol Consumption” published by Yale University, Sec- 
tion of Studies on Alcoholics, Laboratory of Applied Psy- 
chology, New Haven, 1947. 
2See “Definition of Type of Alcoholics,” Page 11. 
3See Page 18 for complete roster of Advisory Committee. Dormitory—patients making beds and cleaning quarters 
Living Room—Staff conference with Comr. A. E. Rose Selection of Patients 
Policies and criteria for selection of patients were 
reviewed and approved by the Advisory Committee. 
Prospective patients were selected from families who 
were either recipients of assistance or applicants who 
were eligible for assistance. In each instance, the case 
worker or intake interviewer referred the prospective 
patient to the Department’s Medical Review Unit tor 
examination by stall physicians. If the examining 
physician found a history of alcoholism or a diagnosis 
of alcoholism, the patient was recommended for ad- 
mittance to Portal House, provided he recognized his 
addiction to alcohol and indicated a desire to over- 
come it. No coercion was used. 
For reasons of expediency (space, staff and budget 
considerations) only male patients were admitted to 
Portal House. Generally, the age level of patients was 
between 30 and 50, but at the discretion of the Di- 
rector, younger and older patients were also admitted. 
No patient was accepted who had a serious infec- 
tion, such as tuberculosis or a communicable venereal 
disease. Patients were also excluded whose alcoholism 
was established as a symptom of serious underlying 
pathology, notably psychoneuroses and psychoses, or 
where deterioration had advanced to the extent that 
treatment could not insure return to self-support. 
Among the first patients admitted to Portal House 
in June, 1947, were a doctor, lawyer, commercial 
artist, professional football player, traveling salesman, 
laborer, bartender, landscape artist, machine operator. 
They represented a cross section of Chicago’s popula- 
tion. They were all men “on relief.” Many of them 
came from Chicago’s “Skid Row.” 
Conception of Treatment 
Hie scope of the treatment plan was conceived to take 
into consideration the total personality of the addict. 
The program was laid out to encompass all known 
effective methods of treatment: 
A. The experience of Alcoholics Anonymous, a 
voluntary national association of some 60,- 
000 former alcoholics who attained recov- 
ery by a method of spiritual reorientation, 
self-discipline and fellowship. Portal 
House method of group discussions par- 
alleled in the main the twelve step pro- 
gram of A. A., a program which in 
chainlike progression offers a rational 
basis for good living. 
Ik The experience of Merchant Marines’ 
Rest Centers set up during the war. 
Concept of Portal House as a resident 
and therefore relatively thorough rather 
than hospital, or temporary, type of treat- 
ment program was inspired by these cen- 
ters. Experience indicated that residence 
treatment enabled the patient more surely to 
follow through on each step of the recovery 
program with ample time under continued guid- 
ance for discussion and practice for each step. 
Selection of Patients 
C. The Yale Plan Clinic lor Alcoholics. General coun- 
seling procedure was based on an apprenticeship 
served by Mr. James Hand in (Director of Portal 
House, and an arrested alcoholic) at the Yale Clinic 
in the summer of 1945. The Clinic was the first 
such laboratory set up by a group of scientists for 
the study of all aspects of the problem of alcoholism. 
Treatment Plan 
The first phase of the program required treatment 
lasting from five to six weeks at Portal House, during 
which time the patient underwent an intensive rou- 
tine of counseling, testing, and work activities. This 
phase was followed by an “out-patient” program last- 
ing from 30 to 90 days, after which the patient was 
still welcome to return to Portal House for advice or 
to participate in group meetings. 
The ultimate goal of the treatment program at Por- 
tal House was to reeducate the alcoholic, to give him 
a fresh outlook and a new grip on life. The program 
combined an integrated plan of group discussions and 
intensive individual counseling, supported by medical, 
vocational and recreational guidance services. 
Group counseling embodied the principle of ethical 
reeducation and retraining in attitudes, which in the 
case of a typical alcoholic usually involved resent- 
ments, intolerance, over-confidence, rationalism, blam- 
ing others for misdeeds of his own. 
He was helped to acquire an understanding of the 
basic rules of responsible group living. 
Director interviews new patient Individual counseling was aimed at helping the 
patient to analyze his personal problems and through 
training in the techniques of self-analysis to gain pro- 
gressively deeper insight. Work therapy contributed 
to the development of stable work habits through a 
growing recognition of the value of profitable and 
satisfying work experience. 
Individual Counseling 
Following admission, each patient was assigned to 
a counselor for an extensive preliminary interview, a 
summation of his case record, the handling and serv- 
icing of such non-alcoholic problems as the patient’s 
social or health condition might indicate. 
This was followed by a second interview in which 
complete details regarding patient’s drinking history 
were recorded by one of the counselors who was an 
arrested alcoholic. Other interviews were scheduled at 
the patient’s own request or as the need for them arose. 
During these interviews the patient was assisted in 
discovering the underlying factors of his illness; was 
given opportunity to discuss confidentially any prob- 
lems with which he felt he needed help. The specific 
case of the individual was considered with a view 
toward gaining deeper personal insight into his par- 
ticular problem and the best way for him to resolve it. 
The emphasis in this phase of the program was to 
develop self-responsibility. The patient was never 
allowed to assume that his recovery could be achieved 
through the efforts of anyone other than himself. In 
all counseling relationships he was helped to reach his 
own decision with respect to possible choices in the 
solution of bis problems. 
Croup Counseling 
A series of 18 to 30 group discussions, led by the 
Director of Portal House, was the core of the treatment 
program. Sessions lasted from \i/2 to 214 hours each, 
depending upon the responsiveness of the group at 
the time of the discussion. The discussions offered 
opportunities for observing patients in action and for 
determining some of their special needs which could 
be handled later in individual interviews. 
Group discussions covered in sequence the Ten Steps 
of Recovery around which the program was built and 
related to an understanding of: (a) The nature and 
effects of alcoholism; (b) Problems to be met during 
the recovery program and the years following. 
After one or two sessions the patients entered active- 
ly into the discussions which were aimed at making 
each of them realize that: 
(1) He must acknowledge the fact that he had lost 
control of his drinking to the extent that he 
could no longer stop at will. 
Individual counseling 
(2) He must accept the fact that he would never be 
able to drink in a controlled manner again. 
(3) He must have a sincere wish to achieve absolute 
sobriety on a continuous and permanent basis. 
(4) He must realize his inability to achieve perma- 
nent sobriety through his own efforts alone, and 
must be willing without reservations to accept 
such aid as he needed. 
(5) He must make as complete an analysis as possible 
of his own character, personality and tempera- 
ment, taking care to include traits in himself 
which he regarded as assets. 
(6) He must draw up a plan for setting right any 
wrongs he had been guilty of doing, being care- 
ful in making amends not to injure any of those 
concerned. 
(7) He must establish a daily routine for performing 
simple recurrent tasks, setting aside time for 
planning in advance the activities of the day to 
come, and concentrating his efforts to the great- 
est possible extent upon the demands of the 
present. 
(8) He must give up his “lone wolf” role and assume 
an active part among those with whom he asso- 
ciated-friends, relatives, neighbors, fellow work- 
ers, etc. 
(9) He must be aware always that continuing sobriety 
alone is not proof of recovery from alcoholism, 
that it is only an indication that recovery is pos- 
sible, that to achieve it he must continue unceas- 
ingly his efforts to maintain a new way of life. (10) He must be as selflessly generous toward others 
as his circumstances permitted, expect no reward 
except repeated opportunity to serve, continue 
to make a self-analysis on a daily basis in order 
to insure a growing breadth of mind as well as 
a healthy balance between humility and self- 
esteem; he must make no promises or take any 
action unless the way ahead was clear; and he 
must avoid acts which might compel apology 
from him or needlessly appear to put another in 
the wrong. 
The emphasis in these discussions was aimed at 
making it unlikely that any patient who completed the 
Portal House program would in the future be able to 
find an adequate excuse for drinking. Subsequent 
testimony indicates that no patient who had a relapse 
actually enjoyed drinking. 
The patient’s realization of what a complete relapse 
might mean to him in the way of physical agony and 
destruction of every constructive thing he had built 
up during a period of sober living—the shock of look- 
ing into such a future only a few hours away—often 
brought him back to his senses in time to save himself. 
Because the Portal House program dovetailed so 
well with the program of Alcoholics Anonymous, 
group discussions were supplemented by one meeting 
each week with a local chapter of the A. A. as well as 
Sunday afternoon meetings for former patients and 
their families. All patients were encouraged to join 
A. A. as a most effective stronghold of sober living. 
The role of A. A. in embracing, guiding, instructing 
and cooperating with Portal House patients cannot 
be over-estimated. The humility and selflessness of 
this group, their ever-ready willingness to respond to 
an emergency—inspired new recruits to help others 
similarly afflicted. 
Psychological, Psychiatric and Other Services 
A short cut to a better understanding of the patient’s 
potentialities was accomplished by administering psy- 
chological tests. Each patient was tested as to his per- 
sonality pattern and occupational preference. The 
psychologist interpreted the tests to the patient with 
a view to helping his adjustment to the realities of 
life. The patient was counseled about avocational 
outlets and was encouraged to pursue those in which 
he showed aptitude and interest. Director and coun- 
selors were guided by the psychologist’s recommenda- 
tion in the total evaluation of the patient’s problems, 
A diagnostic interview was given each patient by 
the psychiatrist and the latter’s recommendations 
helped the staff get a closer insight into the patient’s 
personality. 
Simultaneously, the patient’s medical problems were 
handled by the Department’s staff physicians or he was 
referred to community clinics for whatever treatment 
was indicated. 
Specialized vocational counseling, based on the pa- 
tient’s past work history or newly discovered aptitudes, 
helped the Director, counselors, psychologist, psy- 
chiatrist and physician to move the patient along the 
road to recovery. 
Psychological testing Work and Recreation 
Work therapy was emphasized in the treatment 
program. Several types of projects were utilized in 
connection with the facilities of the Work Therapy 
Section operated by the Department in the same build- 
ing: leather work, weaving, model building, clothing 
repair and alteration, belt making and woodwork. 
Portal House itself had a small wood shop and several 
looms. The occupational therapy workshop of the 
Convalescent Home was used extensively to provide 
opportunity for exploration of vocational aptitudes. 
Other work performed by patients consisted mostly 
of maintenance responsibilities; mopping and scrub- 
bing floors, washing walls and the insides of windows, 
painting, cleaning upholstery, building small pieces of 
furniture, making beds, setting tables, washing dishes, 
making coffee, and helping to serve. Between five and 
six hours of work a day were required from each pa- 
tient. Reasons for assigning this work were carefully 
interpreted to the patient group within a few days 
after admission, and a close tie-up was established be- 
tween the need of the patient to accept social responsi- 
bility and the significance of the work he was required 
to do while in residence. 
Without compulsion the patient was helped to feel 
that he was engaged in useful occupation rather than 
being “made” to work. He was encouraged to indulge 
in his own hobbies or to cultivate new hobbies while 
learning at the same time the art of purposeful relaxa- 
tion. Recreation was a more loosely organized pursuit. 
Card games, chess, ping-pong, and reading were pop- 
ular with most of the patients and it was seldom that 
much special effort was needed in order to help the 
patients find activities in which to interest themselves. 
In good weather a ball game was organized in the park 
and the patients planted and maintained a large gar- 
den in the yard of the Convalescent Home. 
Self Government 
The device of “self government” enhanced the pa- 
tients’ confidence in the program and served to remind 
them of similarities between the experience of com- 
munity living in the treatment center and the phe- 
nomenon of being an integral part of the larger com- 
munity outside. 
The patients themselves were given opportunity to 
put a delinquent member on trial, and it was seldom 
necessary to change the decisions they made. In gen- 
eral, it may be said that the patients were inclined to 
be a little more severe with delinquents than the staff 
and the staff member present at the self-government 
meetings often acted in the alternative roles of defense 
and prosecution attorney, so that favorable modifica- 
tion of the patients’ decisions were possible without 
much difficulty when it seemed desirable. 
The feeling of self-responsibility was further en- 
couraged by permitting patients to come and go with 
a reasonable degree of freedom. This policy was suc- 
cessful in 75% of the cases with one or two serious 
abuses of the privilege in an additional 25%. 
Game of chess Portal house garden 
Nutrition Instruction 
As part of the rehabilitation program, it was realized 
that some nutrition education was essential. The aim 
of discussions was directed toward motivating the men 
to select adequate meals and to eat regularly after 
leaving Portal House. The nutritious meals eaten 
while in Portal House served as the foundation for 
the discussion on normal nutrition. 
Two meetings of about U/2 hours each were held 
with each group of 22 men. A background of normal 
nutrition was given. Some of the points covered an- 
swered these questions. Why eat? What foods are 
necessary in a good diet? Are vitamin supplements 
needed? What is meant by enriched foods? Cost alone 
is not a measure of the best returns in nutrition and 
health. Low-cost foods chosen wisely for needed food 
values may be far better than more expensive foods 
chosen thoughtlessly. Since most of the men would eat 
their meals in restaurants, the purchase of low-cost 
adequate meals was discussed. 
To help visualize the suggested meals, colorful food 
models were used. The charts showing the compara- 
tive nutritive value of various foods, e. g., soda pop 
versus milk, impressed the men. The contribution of 
milk in the diet was given particular emphasis. A 
simple demonstration of the preparation of various 
milk drinks followed the discussion. Material on the 
normal diet as well as leaflets on food suggestions and 
sample recipes were distributed. Experimentally, a 
nutrition movie, Modest Miracle and Something 
You Didn’t Eat, was shown to one group. A short 
discussion followed. The film held the interest of the 
men. 
In preparation for each discussion group, prevailing 
prices in cafeterias and restaurants were obtained. The 
men participated freely in discussing their eating 
habits, food likes and dislikes, and the kind of meals 
they buy. Many questions were asked about food 
values. They showed an awareness of food prices and 
were interested in ways of economizing on restaurant 
meals without sacrificing an adequate diet. 
Suggestions for buying special plate lunches instead 
of ordering a la carte, buying fruit and milk in the 
grocery store instead of in the restaurant were well 
accepted. 
It was apparent that adequate meals and their regu- 
larity played a substantial part in the rehabilitation 
of the men. Follow-Up Care 
Following termination of resident treatment and 
discharge from Portal House, the patient was encour- 
aged to continue contact with an Alcoholics Anony- 
mous group in his neighborhood. He was invited to 
return to Portal House whenever he felt the need for 
consultation about his drinking or personal problems. 
Director and counselors made every effort to assist and 
advise him. 
Before leaving Portal House the patients’ problems 
were interpreted to prospective employers, landlords, 
friends and relatives. Families of patients were oriented 
in a better understanding of alcoholism and the ways 
in which they could help retain recovery. 
In some cases this newly acquired understanding 
brought about family reunions after long separations. 
The Results 
It is unquestionably too early—on the basis of only 
one year’s experience—to draw any proper conclusion 
as to how permanent will be the effect of the treat- 
ment received at Portal House by 163 patients. But it 
can be said that all signs to date are most encouraging. 
Of the first 18 patients who received treatment 
more than a year ago, the record shows that 9 have 
remained continuously sober and gainfully employed 
since their discharge. All are active members of Alco- 
holics Anonymous and return frequently to Portal 
House. The remaining 9 of the original 18 have en- 
joyed varying success, in no case suffering a serious 
enough relapse to necessitate reapplication for public 
assistance. 
Of the 83 patients treated during the first six months 
of the experiment, 28 have remained continuously 
sober since their discharge, 27 others are regarded as 
improved inasmuch as they, also, have not had to re- 
apply for assistance, and the remaining 28 have either 
had serious relapses or disappeared, or both. 
Indications are that the foregoing results will hold 
true in the cases of the 80 patients who were treated 
during the last six months of the experiment. 
It is worthy of note that the cost to operate Portal 
House for one year was approximately $53,000; that 
had the Department been obliged to support the 163 
patients and their families on the public assistance 
rolls for that period the cost would have been approxi- 
mately $68,000. 
Based on the year’s experience, it can he said that 
alcoholics can be helped, that they are worth helping, 
and that it is less expensive to treat those who are 
treatable than to carry them indefinitely on the public 
assistance rolls. 
The following tables describe the 163 patients by 
type of drinker, physical conditions and response to 
treatment. 
Definitions and Analysis of Patient Group 
Alcohol Dependent: One who depends upon alcohol 
regularly to ease certain situations, overcome inertia, 
aid in getting sleep, stimulate appetite routinely, etc., 
but who does not drink excessive amounts of alcoholic 
beverages ordinarily. 
Chronic Excessive Drinker: A heavy drinker who has 
begun to show symptoms of social isolationism, imma- 
turity of reactions, both to situations and to people; 
evinces extreme egocentricity and exhibits abnormal 
responses while drinking such as immoderate loud and 
long laughter, or moroseness, irrational behavior, etc. 
Compulsive Drinker: A heavy drinker who can no 
longer control either his drinking or his behavior while 
drinking, whose life is so maladjusted generally that 
life itself appears to be the insurmountable problem 
waiting to be solved. This drinker is desperate for any 
solution to his all-encompassing problems, no matter 
how irrational the solution might be. 
Chronic Alcoholic: May be chronic excessive or a com- 
pulsive drinker who has developed permanent physical 
and/or mental disorders as a result of heavy prolonged 
drinking. 
Symptomatic Alcoholic: An individual whose alcohol- 
ism is one symptom of another more basic disease or 
maladjustment which, if successfully treated, may be 
expected to eliminate the alcoholic problem as well. 
Such underlying disorders may be among the follow- 
ing, and similar categories: psychoses, marked schizoid 
and paranoid trends, extreme anxiety states, pro- 
nounced hysteria, etc. CLASSIFICATION OF PATIENTS 
Of the 163 patients, 66 or 40.5% of the total were 
regarded as being compulsive drinkers in the light of 
the preceding definitions. Most of these fell into the 
age groups between 36 and 50 years; two-thirds of them 
between 36 and 45 years, with 21 patients in each of 
the 5 year ranges in this 10 year span. 
Chronic excessive drinkers numbered 42 or 25.8% 
of the total, two thirds of whom were found to be less 
than 45 years of age, as woidd be expected, since the 
ages of the chronic excessive drinkers were in general 
somewhat below those of the compulsive drinkers, who 
represent a greater degree of deterioration. 
Twenty seven of the 35 cases of chronic alcoholism 
(three fourths of the cases) were between the ages of 
40 and 60 years, and in general this category was 
slightly older than the category of the compulsive 
drinker. It represents a further step in the direction 
of deterioration. Almost all of the cases of symptomatic 
alcoholism were in groups under the age of 45 years, 
with a majority even under the age of 41 years. This 
can be anticipated since symptomatic alcoholics are 
likely at advanced ages either to be restored to health 
or out of contact with society altogether. The two cases 
listed over 46 years of age may be construed as doubtful 
and may actually represent cases of chronic alcoholism 
in which deterioration has been very marked with 
symptoms resembling those of some other disorder. 
The unknown case was in residence for too short a time 
to permit any determination of proper classification. 
Types of Patients by Age Groups 
Age Groups 
Alcohol 
Dependent 
Chronic 
Excessive 
Compulsive 
Chronic 
Alcoholic 
Symptomatic 
Alcoholic 
Un- 
known 
Total 
Under 20 
— 
— 
— 
— 
— 
— 
— 
20 - 25 
- 
— 
— 
- 
— 
_ 
— 
26 - 30 
— 
1 
1 
1 
3 
— 
6 
31 -35 
- 
10 
5 
1 
3 
— 
19 
36 - 40 
- 
6 
21 
6 
6 
- 
39 
41 -45 
- 
11 
21 
12 
5 
1 
50 
46 - 50 
- 
9 
10 
9 
1 
- 
29 
51 -55 
— 
5 
7 
5 
1 
- 
18 
56 - 60 
— 
- 
1 
1 
- 
- 
2 
61 and over 
— 
- 
- 
- 
- 
- 
- 
TOTAL 
— 
42 
66 
35 
19 
1 
163 
Per Cents 
— 
25.8 
40.5 
21.5 
11.6 
0.6 
100% ADJUSTMENT OF PATIENTS TO RESIDENCE TREATMENT 
I here appeared to be a definite improvement of 
attitude during the residence period in the case of 96 
(58.9%) of the patients. The compulsive drinkers 
seemed to show up best on this evaluation. It may be 
assumed that the chronic excessive drinkers are not 
so likely to feel the need for absolute surrender to a 
new way of life as the compulsive drinkers. The 
chronic alcoholics also show up well on this evaluation 
as could be expected. The symptomatic alcoholics had 
the poorest record. 
Only 33.1% of all of the patients took an active 
interest in Alcoholics Anonymous during their resi- 
dence; that is, went to A.A. meetings outside of Portal 
House on their own initiative. All patients attended 
A.A. meetings which were held in Portal House unless 
they were especially excused. Attendance was optional 
at the one discussion held during the patients’ resi- 
dence that was religiously oriented. Every patient 
elected to participate in it. 
On resourcefulness, all groups were quite low, but 
it must be remembered that alcoholics are out of the 
habit of exercising their resourcefulness, except in 
certain narrow circumscribed ways for from 10 to 15 
years uninterruptedly. The re-birth of this resource- 
fulness is a slow process, and it was encouraging to 
see as much of it evident as there was. For those who 
were able to gain sufficient freedom from old habit 
patterns to show resourcefulness, this flexibility was 
partial insurance against the relapse often excited by 
the alcoholics’ lonesomeness and boredom during the 
early stages of recovery. 
Adjustment by Type of Patient 
Type of 
Drinker 
Chronic 
Excessive 
Compulsive 
Chronic 
Alcoholic 
Symptomatic 
Alcoholic 
Total 
% of 
Total 
(42) 
(66) 
(35) 
(19) 
(163) * 
Improvement of 
Attitudes 
25 
43 
23 
5 
96 
58.9 
Active Participa- 
tion in A.A. 
9 
28 
13 
4 
54 
33.1 
Deterioration 
of Attitudes 
Apparent 
3 
7 
3 
8 
21 
12.9 
No Observable 
Change in 
Attitudes 
14 
18 
9 
5 
46 
28.2 
Wrote 
Autobiography 
19 
30 
25 
9 
83 
50.9 
Attempted 
Making a Self- 
Evaluation 
23 
34 
27 
9 
93 
57.1 
Active in Work 
and Recreation 
Program 
15 
18 
14 
4 
51 
31.3 
Moderately 
Active 
22 
34 
17 
7 
80 
49.1 
Relatively 
Inactive 
4 
10 
6 
9 
29 
17.8 
Resourceful at Dis- 
covering Activities 
to Interest Self 
9 
8 
3 
2 
22 
13.5 
Moderately 
Resourceful 
19 
23 
16 
6 
64 
39.3 
Non-Resourceful 
13 
30 
16 
12 
71 
43.6 
*1 Unknown classification PHYSICAL CONDITION OF PATIENTS 
Nearly one-third of all patients were between the 
ages of 41 and 45 years. Only a little more than one- 
third (39.4%) were below this age range; the re- 
mainder (30.1% of the total) were over the age of 46 
years and less than 61 years of age. These data indicate 
that so far as age was concerned, the patients served 
by Portal House comprised a more or less “normal” 
alcoholic group. 
Analysis of the subjects’ physical condition shows 
that only 71 (43.6%) of the total of 163 patients 
were classified as physically non-handicapped (us- 
ing vocational placement standards as a criterion) ; 
20 (12.3%) had severe disabilities; 47 (28.8%) had 
moderately severe disabilities: and 25 (15.3%) had 
a combination of two or more minor disabilities 
which together indicated individualized placement 
efforts would be necessary. 
Except for individuals classified as chronic alcoholics, 
the disabilities represented in these tables were not 
either directly or indirectly attributable to excessive 
and uncontrolled drinking, so far as could be deter- 
mined. 
Severe disabilities consisted of such defects as an 
amputated limb, serious heart damage, etc. Moderate 
disabilities included moderately severe varicose veins, 
blindness of one eye, lameness of one leg, etc. Minor 
disabilities ranged from hernias to mild forms of 
internal disorders, each of which may be inconsider- 
able in itself as a vocational handicap, but in addition 
to one or more other similar disabilities, becomes part 
of an aggregate that must be regarded as vocational 
or industrial handicap, and one which is only slightly 
less significant, probably, than disabilities classified as 
moderately severe. 
Physical Condition of Patients by Age Groups 
Age Group 
% of Total 
Total 
Severe 
Handicap 
Moderate 
Handicap 
Minor 
Multiple 
Handicaps 
No Physical 
Handicaps 
26 - 30 
3.7 
6 
1 
1 
— 
4 
31 - 35 
11.7 
19 
2 
4 
3 
10 
36 - 40 
23.9 
39 
5 
9 
6 
19 
41 -45 
30.7 
50 
5 
13 
5 
27 
46 - 50 
17.8 
29 
4 
11 
7 
7 
51 -55 
11. 
18 
4 
7 
3 
4 
56 - 60 
1.2 
2 
2 
- 
- 
Totals 
100. 
163 
21 
47 
24 
71 
Per Cents 
100.0 
12.9% 
28.8% 
14.7% 
43.6% RESPONSE TO TREATMENT 
Patients between the ages of 41 and 50 years gave 
the most satisfactory response to treatment from the 
standpoint of age groups. Twenty seven out of the 47 
apparently arrested cases fell in this age range. The 
groups aged 36 to 45 showed the greatest improvement 
short of complete arrestment, but also were responsible 
for the highest percentages of failures. 
Generally speaking, the middle to late middle age 
groups seemed to give the best response to treatment. 
Individuals under the age of 40 years were less willing 
to accept the self-responsibility necessary to recovery. 
Even when they were able to accept the need for 
“settling down” on an intellectual basis, they were in 
too much conflict emotionally to act out the sober 
role successfully. The high percentages of improvement 
shown in these lower age groups give promise for many 
later recoveries. 
Response to Treatment by Age Croups 
Age Groups 
Apparently 
Arrested 
% of 
Age Group 
Improved 
%of 
Age Group 
U nimproved 
% °f 
Age 
Group 
dotal 
in Age 
Group 
26 - 30 
1 
16.7 
2 
33.3 
3 
50.0 
6 
31-35 
6 
31.6 
8 
42.1 
5 
26.3 
19 
36 - 40 
6 
15.4 
15 
38.5 
18 
46.1 
39 
41-45 
14 
28.0 
13 
26.0 
23 
46.0 
50 
46 - 50 
13 
44.8 
8 
27.6 
8 
27.6 
29 
51-55 
7 ' 
38.9 
5 
27.8 
6 
33.3 
18 
56-60 
- 
— 
- 
- 
2 
100.0 
2 
Total 
47 
51 
65 
163 
EARNING CAPACITY LOST BY PATIENTS THROUGH 
EXCESSIVE DRINKING 
Immediately following the conclusion of the first 
step covered in the discussion group series, patients 
were requested to answer a questionnaire which related 
in general to their drinking habits, behavior, and 
experience. In one section of the questionnaire, the 
patient was asked to estimate the number of days lost 
from work each year as a direct result of drinking. 
Detailed instructions were given to insure the estimates 
being as nearly correct as possible. 
This section of the questionnaire was answered 
satisfactorily by 1 13 patients, and the results tabulated 
showed 30% of the patients lost between one and two 
years of employment because of drinking, and 33.6% 
lost from two to three years. The median loss of em- 
ployment was two years and five months. In two 
instances over 90% of the working time available was 
lost; in only seven cases was the loss less than the 
equivalent of one year of employment. 
The loss of work per year amounted to 2.9 months, 
or 89 days. The loss of productivity each year for the 
163 patients served by Portal House amounted to about 
40 man years per annum (or 430 man years within 
the H) year period ending in 1947). II one assumed 
that the average income of this patient group was 
normally about $2,000 per annum, the earning power 
lost because of heavy drinking would aggregate about 
$80,000 per year for the group of 163 patients served 
by Portal House during the past year. The indirect 
losses, of course, are practically inestimable, but would 
certainly increase this estimated direct loss by several 
times. 
Selden 1). Bacon, Executive Secretary of the Yale 
Plan, has asserted that an out-patient facility which 
dealt with 300 patients a year at a cost of .$25,000 would 
pay for itself if it were effective in only 10% of the 
cases. On this basis, an in-patient facility like Portal 
House will pay for itself if it effectively arrests drinking 
on the part of 20% of its patients for one year, ft 
appears then, considering the measurable results of 
Portal House activities, that this treatment program 
has been an eminently sound investment from the 
standpoint of community, social and economic welfare. PSYCHOLOGICAL ANALYSIS OF PATIENT GROUP 
Through psychological measurements it was possible 
to make some objective observations of the effect that 
the environment of the resident treatment in general 
had on the patients as well as of their personality 
characteristics. 
Personality Characterizations of Patients** 
The common personality pattern observed in most of 
the individuals was that of a highly self-centered, 
emotionally immature personality, lacking ability to 
put himself in the other person’s place, restless, tense, 
and predisposed to fear. In varying degrees this pattern 
prevailed throughout. 
The relatively normal individual tended to become 
readily exhausted emotionally; outraged by and fearing 
his own behavior, but more particularly its own conse- 
quences to himself, he appeared to be full of anxie- 
ties—28%. 
The individual becoming dull of understanding was 
one who appeared to have lost the ability to make 
sense out of situations and circumstances to a greater 
or less extent; he appeared to have lost inner balance. 
He showed lack of resilience in comprehension and 
wasted his energy through compulsive thoughtless 
action to which he might be prompted by any stimulus 
which was exerted from outside of himself—27%. 
The withdrawing personality might be described as 
an emotionally stilled person who found difficulty in 
making and sustaining social contacts; he showed a 
tendency toward lack of inner balance, but exhibited 
responsiveness to memories, imagery, etc. He responded 
with anxiety and feelings of inferiority to what he 
regarded only as the puzzling world existing outside 
of himself—10%. 
The personality drifting into unreality showed an 
even greater trend toward withdrawal which resulted in 
wishful thinking as a substitute for rational activity 
in meeting his needs. Closed within his own private 
world he was clearly at odds with his environment— 7%. 
The personality reduced to apathy was one whose 
normal expression had been largely replaced by anxie- 
ties, and whose personality had become so severely 
impoverished as to make his existence apparently 
almost unworthy of the effort made to maintain 
it—5%. 
The over-actively functioning personality was one in 
which feeling and imagination appeared to be highly 
pitched with an immoderate drive toward activity for 
its own sake, alternating between the extremes of bril- 
liance and nervous exhaustion—2%. 
1 he personality in which over-activity had become 
an obsession showed greatly weakened restraint be- 
cause of the accelerated momentum of an imagination 
which had outrun reason and fostered wishful thinking 
about a private world that imposed no limitations on 
one’s extravagance except for his need to keep a pre- 
carious toehold on reality—12%. 
1 he mentally diseased patient resembled an indi- 
vidual who might have been in the acute delirium of 
alcoholism, but with him the signs of dementia would 
persist to such an extent that an exhaustive phychiatric 
examination was indicated—9%. 
Intelligence and Related Factors for 
Group of 83 Patients 
1. Average Intelligence: Corresponds to I.Q. 1.16 
(“Bright normal” adult). The intelligence of the mid- 
dle 50% of the group ranges from l.Q. .97 (average 
adult) to I.Q. 1.23 (superior adult). Lowest: l.Q. .89; 
Highest I.Q. 1.40. 
2. Average available intellectual energy (available 
intelligence): Corresponds to I.Q. .80-.90 (dull normal 
adult) : Lowest: I.Q. ,72; Highest I.Q. 1.06. 
3. Mental deterioration: Found in 31 out of 83 cases 
(37.3% of entire group). lire “deterioration” of the 
middle 50%: From 6.75% to 20.25%. (Mental dete- 
rioration is here a measure of premature slowing down 
in mental ability.) 
4. School level achievement: Average of First Year of 
High School. The middle 50% ranges from 8th grade 
up to 3rd year of High School. Lowest: 3rd grade; 
Highest: 5 years of graduate work. 
Personality Changes During Residence 
Continuous reminders to practice living each day out 
fully were aimed at impressing the patient with his 
need to avoid existing in either the future or the past 
in order to insure freedom from accumulating tensions 
and anxieties that would drain away energy needed to 
meet the demands of the present. Retesting of patients 
after four to six weeks of residence revealed significant 
changes suggesting that there were new developments 
within patients generally while they were in residence. 
(1) There were measurable indications of a general 
increase in emotional maturity on the part of the 
patient. 
(2) Tensions and anxieties change character fre- 
quently with an intensified effect on the patient. 
Activity in the fellowship of A.A. provided the 
avenue needed for guiding the patient through 
this period, in many instances. 
*#The tests used were Rohrschach Psychodiagnostic Test, 
Pressey X-O "Pests I, IV, Form A Investigating the Emo- 
tions; Wechsler-Bellevue Adult Intelligence Test; SRA 
Primary Mental Abilities Test. 
Based on records of 100 patients, June 1947 to June 1948. (3) The patient tended to attempt taking in more of 
his environment than he could manage, or to 
become fascinated by insignificant, often unreal, 
ideas that offered temptation in the way of wish- 
ful thinking; such ideas were impermanent, how- 
ever, and would rapidly give way to more practical 
point of view. 
(4) The patient's intellectual energy in general 
showed a marked increase, but with considerable 
variance among individuals. 
(5) An unconscious rebelliousness seems to be replaced 
in the patient by a deep yearning to belong, a 
new awareness of social canons, and a tendency 
to “go along” instead ol insisting on his former 
highly individualized pattern of behavior. 
(6) A growing sense of reality was especially notable 
among those patients who had appeared to have 
sunk into apathy. 
All in all the changes observed to have taken place in 
the personalities of the patients might be reasonably 
regarded as great and real gains, even though in two 
of the four statements given above, it would appear 
that the patient had lost ground rather than made a 
gain. Actually, even these apparently adverse develop- 
ments arc hopeful indications so far as eventual re- 
covery is concerned. 
COMPARATIVE COSTS OF EXPERIMENT 
What were the costs of the experiment? What would 
have been the costs to the Department of Welfare and 
to the community had there been no alcoholic therapy 
project for the 163 clients eligible for general assistance 
who were admitted to Portal House? 
Total costs of the Portal House Program for these 
163 patients in the period from June 1947 to June 1948 
amounted to $52,800. This figure does not include 
investments in equipment and fixtures and deprecia- 
tion of investments. It covers: 
1. Costs of examination of eligibility for both gen- 
eral assistance and alcoholic therapy under the 
Department of Welfare programs. These intake 
costs amounted to about $8.50 per case. 
2. Costs of residence in Portal House including the 
“transition periods” when clients sought employ- 
ment and living arrangements outside of Portal 
House. These costs amounted to about $4.00 
per day. 
3. Costs of contact with patients by Portal House 
staff subsequent to Portal House residence. These 
costs averaged about $1.00 per day. 
4. Costs of general assistance to patients and their 
families during and after Portal House super- 
vision including administrative costs. These costs 
amounted to an average of about $.80 a day per 
patient. 
Table II. Days of Supervision for 163 Patients, 
by Stage of Treatment 
Stage ol Treatment Days under Supervision 
All Stages 13,000* 
Residence: 
Full time 5,100 
Transition 1,900 
Follow-up 6,800 
a Following Portal House supervision general assistance 
continued for 8,000 additional days up to June 1948 or 
closing of case. 
Without the alcoholic therapy program the Depart- 
ment of Welfare would have supported through gen- 
eral assistance each of the 163 unemployable patients, 
and in 23 cases their families, from date of Portal 
House admission to June 1948 or in certain cases 
earlier. The exceptions might be considered to be the 
four patients who died from causes other than alco- 
holism, the nine who were transferred for care in a 
State Hospital, and the 26 who left with whereabouts 
unknown. 3 For these the assumption is made that 
general assistance continued until the date the case was 
actually closed. 
Based on the foregoing assumptions, administrative 
and assistance costs of the general assistance program 
without alcoholic therapy would have amounted to 
about $68,700 for approximately 26,000 days of care, 
or about $2.64 per day. 
Table III. Estimated Cost of Support Under the 
General Assistance Program for the 163 Portal 
House Cases Had There Been No Portal House 
During Period June, 1947 to June, 1948° 
Table I. Cost of Program 
June, 1947 to June, 1948 
Classification 
Amount 
Total .. 
|52,800. 
Examination of Portal 
House applica- 
tions 
1,400. 
Care during: 
Residence Period . 
- 27,700. 
Follow-up Period 
6,700. 
General Assistances. 
............. 17,000. 
a Covers support under the 
general Assistance program 
provided patients and their families during the period of 
residence and until the case 
was closed or the end of the 
Portal House experiment. 
Total |68,700b 
Assistance 62,200 
Administration 6,500 
a Based on the assumption that the 163 persons given 
treatment at Portal House would have received continuous 
general assistance from the date of admission through the 
survey period except for those cases for which it is assumed 
general assistance would have been discontinued earlier, 
b Covers cost for a total of 26,000 days of care. 
i Those who died had been under care from 40 to 150 days; those 
transferred to a State Hospital from 59 to 169 days; those who 
left with whereabouts unknown from 4 to 144 days. The difference then of $15,900 between costs under 
the general assistance program without Portal House 
estimated to be $68,700 and the costs of the Portal 
House program amounting to $52,800 represents sav- 
ings to the Department of Welfare in a year’s operation 
of the Portal House demonstration. 
Of course, these savings are minimum, when it is 
considered they would be increased with the extension 
of time. Continuance of the Portal House demonstra- 
tion for persons who were still in residence and others 
still under supervision at the close of the demonstra- 
lion period would result undoubtedly in a higher 
proportion of patients who were employed and whose 
chronic alcoholism was apparently arrested, thereby 
reducing Portal House costs per case. And a considera- 
tion of only general assistance costs over a longer 
period of time would show these alternative costs to 
be higher. 
Beyond savings in dollars and cents to the Depart- 
ment of Welfare should be considered also what the 
program meant to patients and their families and to 
the community. 
ADVISORY COMMITTEE 
CHAIRMAN: 
DR. ANTON J. CARLSON 
Professor Emeritus of Physiology 
University of Chicago 
Chairman, Committee on Alcoholism 
VICE-CHAIRMAN: 
DR. ANDREW C. IVY 
Vice President, Chicago 
Professiona 1 Colleges 
University of Illinois 
COMMITTEE 
MISS JEANETTE HANFORD 
Assistant General Superintendent 
United Charities of Chicago 
DR. FREDERICK HILLER 
Northwestern EJniversity 
DR. WILLIAM F. PETERSON 
Director of Research 
St. Luke’s Hospital 
DR. RUDOLPH G. NOVICK 
Medical Director 
Illinois Society for Mental Hygiene 
DR. DAVID B. ROTMAN 
Director, Psychiatric Institute 
M unicipal Court of Chicago 
(Deceased June 1948) 
DR. DAVID SLIGHT 
Acting Superintendent 
Veterans Rehabilitation Center 
Illinois Dept, of Public Welfare 
MISS MARY A. YOUNG 
Executive Secretary 
Division on Family and Child Welfare 
Council of Social Agencies 
DR. H. O. LINDHOLM 
Medical Director 
Washingtonian Home of Chicago 
MISS JESSIE F. BIN FORD 
Executive Director 
Juvenile Protective Association 
MR. WALTER O. CROMWELL 
formerly Director of 
Community Conditions 
Juvenile Protective Association 
DR. FRANCIS J. GERTY 
Director, Illinois 
Neuropsychiatric Institute THE FRED J. RINGLEY CO., CHICAGO 
>83 A fresh start