Help For The Alcoholic And His Family
Though I have worked with hundreds of alcoholics in my years as a counselor, it is still a sad undertaking for me to describe the long and relentless disintegration of the human being brought about by that chemical dependency. Unless someone intervenes to change the scenario, the alcoholic’s story is, in the fullest sense of the word, a tragedy.
Since the deteriorating condition and behavior of a chemically dependent person are so closely intertwined with what happens to everyone else in the family, we need to understand exactly what is taking place at various stages of alcoholism and the symptoms by which these changes can be recognized. It is just as important, if we are to act compassionately, to know what the disease feels like to its victim.
So we will trace the process of chemical dependency from the first experimental use to total physical addiction. For our protagonist we will use an alcoholic, a middle-class American family man-the type of dependent seen most often in treatment facilities. But let me say that dependency does not respect age, class, gender, or life-style. And it matters little whether the drug is alcohol, heroin, amphetamines, prescription drugs, or another of the dangerous chemicals with which people in pain try to change their moods. Although we will focus on the adult alcoholism here for convenience, the growing dependence of a youngster on some other drug follows a similar pattern and certainly is no less tragic.
The Process of Chemical Dependency
All drinking starts out as social drinking. Most people in our society drink alcoholic beverages at least occasionally. Young people are usually introduced to their first experience with alcohol in the teen years-sometimes earlier. For many, drinking becomes a regular part of social activities while they are still in high school.
The sort of experience a youngster has in his first experiments with chemicals depends on the type of chemical, its purity, and ingested; the situation in which it is used, whether at a party, in a crisis, or while alone; and the emotional state of the person at the time, whether excited, happy, depressed, or in pain. If the experience is positive, it leads to an important discovery: Chemicals can change how you feel. If Cindy finds that alcohol makes her feel more confident and outgoing, and if Tim finds it helps him forget that he’s flunking math or losing his girlfriend, then an indelible lesson been learned. The greater the mood swing the more clearly the lesson is imprinted.
The next time those young people want a change of mood, the answer seems obvious – have a drink! A positive experience with one chemical sometimes encourages them to try others. They may decide that alcohol is more effective for certain situations and certain kinds of mood changes, other drugs for others, so they use either or both according to the effect they desire.
For most people this early learning about alcohol is the beginning of a lifetime pattern of “social drinking.” (That rather imprecise phrase generally refers to drinking in moderate amounts at meals or on social occasions.) But for every 10 or 15 experimenting youngsters who can look forward to years of uneventful use of alcoholic beverages, at least one other has taken the first step towards alcoholism.
In time many people move from learning the effects of alcohol to seeking them whenever they want a change of mood. This is still considered social drinking and a common occurrence in today’s high-pressure living. “What a day! Let’s have a drink!” Now and then, that one drink may turn into three or four, or six or seven if the problem is big enough or the occasion special. The evening ends in intoxication, and morning brings a hangover. Yet, it may somehow seem to have been worth it. “After all, it was New Year’s Eve!” Or, “A guy doesn’t get a raise every day.”
Some drinkers will find that as months or years pass, they are gradually consuming larger quantities and more often. Their drinking may not yet be excessive enough to attract attention, especially if heavy alcohol use is common in their social groups. But chemicals affect more than one’s mood. While the mind is enjoying euphoria, the body is slowly adapting its chemistry to this stranger that seems to have moved in to stay. At some point the drinker notices that he has to drink more to get the same “buzz.” Two or three drinks used to wipe out the day’s worries; now it takes five or six.
Whatever the chemical explanation for why the body’s reaction changes, one thing is certain: acquired increased tolerance is an early warning to the heavy social drinker that serious trouble lies ahead.
If that warning goes unheeded-as it most likely will in the incipient alcoholic-and larger quantities are ingested to get the old relief, sooner or later another warning sign appears. He has his first blackout. This is a chemically induced form of amnesia that occurs with regular, heavy use of alcohol or other mood-altering drugs. At first, blackouts may last only a minute or two, but as dependency develops, entire evenings and longer can be lost. Blackouts can occur to a dependent when he has not been drinking, and they continue for a long time after he has stopped and is detoxified.
The onset of blackouts is a frightening development. It can cause personal and job problems that are costly and hard to explain because neither his companions nor the victim himself has any clue that the blackout is happening. He talks and acts normally, does not lose consciousness, and may not even show any signs of intoxication, but for the period of the blackout nothing gets written on his memory. He can make promises, hear class assignments, negotiate business deals, incur debts, and have no idea afterward that he has done so.
There is not total agreement in the field of alcoholism studies as to exactly when the social drinker crosses the invisible threshold of harmful dependency. However, blackouts are a phenomenon unique to the prolonged, heavy intake of mood-altering chemicals. In my opinion, the occurrence of the first blackout is evidence that the user has become “hooked.”
Up to this point, the emphasis has been gradually shifting from social drinking to social drinking. Once dependency sets in, alcohol is no longer consumed as a beverage but as a drug. Where drinking was once a matter of conviviality and pleasure, it is now a matter of need. The dependent begins to become preoccupied with alcohol. “Will they serve something more than just a glass or two of wine tonight? Maybe I’ll have a couple before we go . . . .Hmm. I’ll toss this one down and get a refill before they serve dinner . . . . It’s eleven o’clock and nobody’s mentioned a nightcap. Wonder if there’s anything left in that bottle I stashed in the trunk of the car.”
He begins to sneak drinks, aware that he is drinking more than the people around him. “They don’t understand-I need it.” But all the same, he feels guilty. Much of the time and money he once devoted family is now going to alcohol. From time to time his drinking causes trouble with his wife or friends or employer. All this increases the load of and his self-worth begins to erode.
Early in his drinking career the dependent drank to his mood from normal to euphoric. Now his emotional pain is so great that the best he can hope is a change from bad to normal. Euphoria is gone. When a person no longer gets “high,” when he drinks for relief rather than pleasure, it is a sure sign he is in trouble with alcohol.
Meanwhile, his blackouts are becoming longer and more frequent. One cannot have a long blackout and return to normal the next day-the life complications are just too great. Nothing is more pitiful than hearing an alcoholic describe how it felt to wake up in the morning to find the front end of his car smashed-and have no idea where or how it happened.
As the addiction progresses, blackouts can last for two or three weeks. I recall one man who came to our center for help after his boss had confronted him about his drinking. He seemed to sincerely want treatment to help him stop. He took the information we gave him about hospitals and left, presumably to be admitted to one of them. But he never arrived. Nearly three weeks later he walked into our office again, and once again he asked for information-just as though he had never been in before. As far as he was aware, he hadn’t; he had been in a blackout since before the first visit. On being questioned, he told us that the last thing he remembered was leaving home one morning to find help. How long ago that was and where he had been ever since, he had no idea, and he would not have until the credit card bills came in. He later discovered he had been all over the country, staying in motels, spending money, and he knew not what else. The not-knowing is one of the terrors of the blackout.
Inevitably, episodes like this increase the alcoholic’s already heavy burden of guilt and feelings of worthlessness. He needs relief more than ever, and for him relief is spelled alcohol. But now even relief is elusive and costly, because he must consume much more alcohol to get it.
Loss of Control
Sometime before the average alcoholic’s blackouts become as bizarre as in the story just related, the next critical event occurs-loss of control. Until now, despite the clear signs of a growing dependency, the drinker could still stop drinking when he chose to. Once loss of control sets in, that ability is lost. He can still make a choice whether to take the first drink of a bout, but after one or two, he no longer has that option. In the words of E.M. Jellinek, pioneer investigator of alcoholism as a disease, “Loss of control means that any drinking of alcohol starts a chain reaction which is felt by the drinker as a physical demand for alcohol . . . . [The bout] lasts until the drinker is too intoxicated or too sick to ingest more.”‘
With his behavior often literally out of control, the dependent begins to encounter a lot more pressure from the people around him. They become concerned and warn him; they become angry and threaten him; they become hurt and weep. For a while their attempts to end drinking seem to be meeting with some success, for many alcoholics “go on the wagon” at this stage. But the ride is usually short. The pain in their lives has become so great by this time that it cries out for relief. So the alcoholic steps into a bar, sincerely intending to have “only a couple,” but he ends up drinking until after midnight. It will be a long while yet before he realizes, and admits to himself, that he can never again take “a couple of drinks.” This is why complete, permanent abstinence is so important to recovery.
All of us face times when the pressures of life get almost too heavy, when we are filled with painful dealings and our self-worth is low. At such times the natural human tendency is to fall back on certain universal psychological defenses to protect us from further attack by those around us and by ourselves. The alcoholic is no exception.
As soon as his drinking began to cause complications in his everyday life, he called out the time-honored defenses of denying, avoiding, blaming, making excuses and all the rest. But those early difficulties were nothing compared to the pain, problems and personal criticism that follow loss of control. He feels shame at his frequent episodes of complete drunkenness and the continuing failure of his best efforts to stay sober; he feels guilt at his neglect of his wife and family; he feels hurt and lonely as become fewer and fewer; he feels frightened as his job situation becomes precarious and debts mount To admit his predicament would bring more pain than he could handle. (This is one of the reasons for the high suicide rate among chemically dependent people.)
So psychological defenses of one sort or another come to dominate all his interactions with others. This defensive behavior is so predictable and consistent among alcoholics that a counselor can quickly recognize it.
He alibis. “I didn’t drink too much last night. It was just those enchiladas that made me sick.”
He blames. “If I had a wife who cared about me, I wouldn’t have to go out with the boys at night.”
He threatens. “Don’t try to tell me what time I ought to be home for dinner – I’ll come home when I’m good and ready!”
He charms. “Aw, come on, honey. Let’s forget about it and start over. I’ll be different this time.”
He boasts. “I’m the only guy in that whole shop that’s worth a nickel. Why, you ought to the see the mess there when I don’t make it to work for a couple of days!”
He avoids. “If they’re so stiff a fella can’t have a couple of drinks, I don’t want to go there any more.”
Such tactics may temporarily silence the accusers without, but not the harsher accuser within. The dependent’s last resort is repression. In order to survive, he turns off his painful feelings, keeps them turned off with more alcohol, and buries them somewhere deep in his subconscious. Unfortunately, positive feelings like love and compassion-the feelings on which relationships are built-get buried along with the negative ones. And in order to lay his feelings to rest, much of the objective truth about his situation must be repressed, too. As a result, he gets further and further out of touch with reality.
This growing delusion is reflected in his defensive maneuvers. The alibis are but a statement to others of the rationalizations that he is telling himself. The blaming is simply a reassignment of his own guilt, which he has transferred to someone else by projection. The boasting is a voicing of the grandiose delusions with which he has unconsciously filled the vacuum that was once his self-esteem.
Sometimes, though, even these bulwarks fail, and misery overruns his most elaborate defenses. Then he sinks into black remorse, followed by renewed periods of abstinence. Or, still denying his by now evident loss of control, he may set up rules to govern the time, place, and circumstances of his drinking, vowing to be faithful to them.
Such resolutions are, of course, predestined to fail, and the dependent finds himself back where he started but a little worse off. Such is the downward spiral of dependency. His life now revolves more and more around alcohol. He hoards and hides bottles. If he has not already lost most of his friends, he drops them-except for drinking companions. He loses any remaining interest in outside activities. If he has not already lost his job, he may decide to quit it. He will give any of a thousand reasons, but the truth is that he could not handle it and his drinking, too. And the drinking is no longer a matter of choice.
In fact, less and less of his life is a matter of choice. He is trapped in a pattern of compulsive behavior that is controlled by his physiological dependence and his psychological defenses-both completely out of his awareness.
Through the long ordeal of his growing dependency his family may have stood beside him, protecting him and picking up the responsibilities that he was gradually abandoning. In fact, they have probably done so with a pathology to match his own. But sooner or later, even these ties wear thin. His spouse and children are likely to leave him literally or simply to close ranks for mutual support and survival, leaving him emotionally alone. This is also a point at which they may be motivated to seek outside professional help.
As the alcoholic’s isolation thus deepens, he becomes increasingly egocentric. He is touchy, takes offense unreasonably at the slightest provocation, and indulges in extravagant self-pity, perhaps the only conscious emotion of which he is still capable.
The prolonged heavy intake of alcohol that has brought the dependent to this desperate emotional state has taken its toll on his body, too. Now the damage begins to make itself known. He is likely to have his first hospitalization for a condition related to drinking.
Hospitalization means, of course, abrupt and complete separation from the one thing that he is sure he cannot do without. And the next few days may prove him rim. When his alcoholism has progressed beyond a certain, suddenly allowing the concentration of alcohol in the blood to drop from its usual high level will precipitate a crisis. The withdrawal symptoms that follow-convulsions, hallucinations, delirium, delusions, and tremors-are collectively “the only criterion for the development of physical dependence upon alcohol.”2
With withdrawal symptoms, the body is making a clear and dramatic statement that physical addiction is now complete. In order to live with the continuing presence of large quantities of alcohol, the cells have slowly adapted by incorporating the chemical into their metabolic script. Where once they could not function normally with alcohol in the blood, now they cannot function without it.
A life-threatening experience like withdrawal may reactivate all the alcoholic’s old resolutions about sobriety. It may even be the crisis needed for him to be willing to accept treatment. But unless he does get effective treatment, and unless he is highly motivated to change, the weeks or months following hospitalization will be only a brief pause in the long downward journey.
Just before or just after the alcoholic gets clear evidence that he has become physically addicted, his drinking behavior takes a new turn. He begins looking for a morning drink to steady his nerves and numb his physical and emotional discomfort-that “hair of the dog” without which he cannot face the day, perhaps cannot even get out of bed.
Until this point, drinking, however heavy and uncontrolled, was probably limited to evening use or an occasional weekend afternoon. Now the morning drink must be followed by reinforcements at intervals during the day-perhaps at coffee breaks and lunch.
Morning drinks, daytime “nipping,” then weekend “benders” (prolonged intoxications lasting days rather than hours)-and life as usual is no longer possible. Maintaining a full-blown addiction becomes a full-time job. Thus, Jellinek believed that the “bender” heralds the end of what he called the “crucial” period of alcoholism and the beginning of the “chronic.”
In this last, chronic stage, as in high tragedy, the whole complex of dire developments that have been taking place over time now descend on the central figure with their full impact. For a concise description we can do no better than to quote Jellinek, whose restrained clinical language only accentuates the harsh reality of what it is telling us:
This later drinking behavior meets with such unanimous social rejection that it involves a grave social risk. Only an originally psychopathic personality or a person who has later in life undergone a psychopathological process (such as alcoholism) would expose himself to that risk.
These long-drawn-out bouts commonly bring about marked ethical deterioration and impairment of thinking, which, however, are not irreversible. True alcoholic psychosis may occur at this time, but in not more than 10 percent of all alcoholics.
The loss of morale is so heightened that the addict drinks with persons far below his social level in preference to his usual associates-perhaps as an opportunity to appear superior-and, if nothing else is available, he will take recourse to “technical products” such as bay rum or rubbing alcohol.
A loss of alcohol tolerance is commonly noted at this time (reversing the increased tolerance acquired earlier). Half of the previously required amount of alcohol may be sufficient to bring about a stuporous state.
Indefinable fears and tremors become persistent. Sporadically, these symptoms occur also during the crucial phase, but in the chronic phase they are present as soon as alcohol disappears from the organism. In consequence the addict “controls” the symptoms through alcohol. The same is true of psychomotor inhibition, the inability to initiate a simple mechanical act-such as winding a watch-in the absence of alcohol.
The need to control these symptoms of drinking exceeds the need of relieving the original underlying symptoms of personality conflict (emotional pain), and the drinking takes on an obsessive character.
In many addicts, approximately 60 percent, some vague religious desires develop as the rationalizations become weaker. Finally, in the course of the frequently prolonged intoxications, the rationalizations become so frequently and mercilessly tested against reality that the entire rationalization system fails and the addict admits defeat. 3
The tragedy is complete. The dependent has lost everything, even his alibi. He is left with nothing but his pain.
Where Do the Victims of Alcoholism Turn for Help?
In the last half century, two strong yet distinct traditions have developed to deal with the tragedy of alcoholism: Alcoholics Anonymous (AA) and the alcoholism treatment profession.
AA is the most established organization that provides assistance to alcoholics. Founded in 1935 by two alcoholics in search of recovery, it now has thousands of local groups around the world. AA is not connected with any religious denomination, group or cause. Its services are provided free of charge. Newcomers are warmly welcomed, and the only requirement for membership is a sincere desire to stop drinking. For relatives and friends of alcoholics, there are two related fellowships: Al-anon for adults, and Alateen for teenagers.
The second approach, professional alcoholism treatment, has emerged as a distinct specialty in the last 15 years. The field embraces two broad groups: trained counselors in the treatment of chemical dependence, and helping professionals (such as physicians, nurses, psychologists and teachers) who have attended training sessions to add this specialty to their credentials.
The following story illustrates what treatment would be like for a family that was able to make use of both resources. Obviously, both resources will not be available in every situation. But I am convinced that the two, when working in harmony, achieve more than either one can by itself.
The Story of George
George W., after drinking heavily for more than 12 years, had become totally dependent on alcohol. Last year he lost his job and soon after received a stern warning from Dr. Brown, the family physician, that his liver was in bad shape. His wife, Anne, felt desperate, but she did not know where to turn for help. At a friend’s suggestion she called Alcoholics Anonymous. A kindly sounding voice on the other end of the line invited her to an Al-anon meeting the next evening. That was the first step in a new direction for the whole family. (Another family might have begun their recovery from the other side of the fence-at a treatment center.)
Anne felt nervous as she drove to the meeting, but her fears were soon put to rest. At the door she was greeted by two smiling women and a man. “I’m Marie,” “I’m Evelyn, and this is Jim. We use only first names.” No questions, just a warm hello. Anne knew at once that she had been right to come.
During the meeting several members talked about their family problems and the pain they were feeling-the same problems and pain she had been trying to handle all alone for so many years. Others told how they had managed similar situations, sharing ideas that they had found successful, and unsuccessful, for there was no pretense, no covering up. Through the whole interchange was a gentle sense of caring, understanding and appreciation for one another’s hurting. Anne did not join in the discussion, but when the meeting was over, she felt as if a little of the load she’d been carrying for so long had been lifted. She walked out of the meeting room with a handful of reading material about alcoholism, AA and Al-anon, plus several phone numbers of members she could call at any hour, day or night, if she needed help.
A couple of weeks later, Anne did tell her story, ending with her talk with Dr. Brown. He had recommended that, since George refused to get help for himself, she see a counselor at the Elmridge Hospital treatment center. She confided she had been agonizing over that advice for a month now. To go seemed like such a disloyal thing for a wife to do; George would blow his top! When she finished talking, one of the Al-anon members gently disagreed. So did another, then another. They pointed out that it would, on the contrary, take a great deal of love to risk George’s anger in order to help him. “Tough love” they called it. By the end of the evening they had convinced her that the real disloyalty would be to let George go on drinking himself to death. The next day, knowing that she was backed by the moral and-if she needed it-practical support of her new Al-anon friends, she made the appointment at Elmridge.
(If Anne had lived so far from the nearest treatment facility that she could not go there for weekly visits, she might have found a physician, family counselor, or other professional in her community with special training to help victims of chemical dependency. Here again she could have turned to the other Al-anon members for advice.)
It took only a few minutes with the counselor for Anne to know that she had made another right decision. He seemed to know what had been happening in their family even before she told him, and he said he thought he could help.
Near the end of their hour together, he told her about a process called “intervention,” explained how it worked, and asked if she was willing to take the risk. She said she was, and they made another appointment. The counselor asked her to bring her son Robbie, 15, along the next time.
For five weeks Anne and Robbie met with the counselor. He helped them in dealing with some of their own feelings as well as preparing to confront George. Anne also went on attending Al-anon, where the concern and experience of the other members gave her some good ideas for managing problems at home. They also bolstered her resolve to intervene with George when she became frightened and tempted to give up. Meanwhile, Robbie started attending Alateen meetings and discovered, to his surprise, that he wasn’t the only kid in the high school who had an alcoholic parent. It felt good to be able to tell someone how he felt-how confused and angry and scared he was-and to know he wasn’t alone.
By the day they had set for the intervention, both Anne and Robbie were feeling stronger and more hopeful than they had in several years. The counselor had worked with each of them, helping them let out some of the feelings they had buried so long and so deeply that they didn’t even know they had them. The whole picture of what had been happening at home was beginning to get clearer. They could now see that although George was the alcoholic, they too had been helping to make the situation sick and keep it that way.
The intervention had been carefully planned. Anne was nervous but determined. Dr. Brown came over to join them and added his medical prognosis to the avalanche of evidence they had prepared to convince George he needed help. At first George shouted and blustered and threatened to walk out, but he didn’t. After a little while he just sat looking blankly at the floor, pale and shaking. In the end he collapsed in tears and agreed to stop drinking and accept help. Anne had packed George’s suitcase so he could enter Elmridge as an inpatient that afternoon. The counselor and Anne had made sure a room would be waiting for him.
George was hospitalized at Elmridge for a month. He had both private and group counseling and begun attending an AA group for patients. The counselor worked closely with the AA principles, using the Twelve Steps as a framework for George’s program of recovery. By the time he was ready to leave the hospital, George had put on a few pounds, his color had improved, and he felt as though life might yet be worth living.
Meanwhile, Anne and Robbie had a few more individual appointments with the counselor. They also started going to peer group meetings at the center, Anne with other wives of alcoholics, Robbie with other teenagers. In some ways these were like Al-anon and Alateen meetings, but not exactly; for one thing they were always led by a trained counselor. They offered still another way for Anne and Robbie to learn more about themselves and the things they were doing to make their lives unmanageable.
The day George went home a sober man was a landmark day for the whole family. They were all in this together and had all been working hard on their own parts of the problem. But George’s leaving the hospital didn’t mean they would sever their ties with Elmridge. They still had a lot of work to do as outpatients. George continued to attend meetings of the AA group, where he had made his first close friends in 15 years-closer perhaps than ever before; because of the honesty required in AA, they knew him as no one ever had before. And Anne and Robbie continued to attend Al-anon and Alateen, where they, too, had found satisfying friendships.
(If there had been no local inpatient facility, the counselor would have recommended one in another community, or possibly a local hospital, if its staff were sensitive to the special problems of chemical dependency. Unlike George, the alcoholic who is hospitalized out of town must, on release, make a transition from the familiar support group at the treatment center to an AA group back home, which he has never attended. Now the family’s already warm ties to the companion Al-anon group can serve. as a needed bridge.)
The first week George was home, the whole family went to see the counselor together, for the first time since the fateful day of the intervention. He told them that they had all done a lot of growing as individuals in the last few weeks and that now he would like to help them grow together as a family.
From that time on, they all met with the counselor once a week. They were free to talk about problems that had arisen during the week or whatever else was on their minds. The counselor seemed to pay less attention to what they said than to how they said it. He would often interrupt the discussion to ask how they were feeling about what they had heard or to point out how they were reacting. They found that gradually they began to notice their feelings and reactions themselves, even when they were talking at home without the counselor.
During this period they shifted from three separate peer groups to a single group of four families who met with the counselor one evening a week. They had learned of other alcoholic families’ problems in AA, Al-anon and Alateen, and also in their peer groups, but this was the first time they had a chance to observe a whole family together in the same meeting. They could see a lot of reasons these families were having frictions and realized that they were creating some of the same problems for themselves.
After a couple of months of after-care, they found that their family discussions were no longer ending in angry words or tears or someone’s having to give in to keep peace. They could talk about their problems and find answers that satisfied everyone. Best of all, they discovered they could actually enjoy being together. They spent a lot more time now talking about happy things-family outings, news of AA friends, plans for the future.
The counselor began to talk to them about the future, too. What did they want for themselves as individuals in the months and years ahead? As a family? Those were questions that they hadn’t dared face for so long that at first they had trouble answering. He helped them look at their present growth, their possibilities, their values, and their dreams. Gradually they started to lay some plans for how they could make their hopes become realities.
After three months of family care, the counselor announced that he felt they were ready to continue their recovery on their own. He reminded them that although the alcoholism had been arrested, it would never be totally cured. If any of them slipped back into his old ways, he might find himself back in trouble. To keep their gains and go on growing, they would need some source of support. The counselor recommended that they continue attending their AA, Al-anon and Alateen meetings indefinitely, and they each knew in their hearts that they would. The warmth and understanding they had found there was one of the most valued parts of their new lives.
The above article, “Help for the Alcoholic and His Family,” is written by Sharon Wegscheider. The article was excerpted from a pamphlet produced by Focus on the Family in 1992.
The material is most likely copyrighted and should not be reprinted under any other name or author. However, this material may be freely used for personal study or research purposes.